Provider Demographics
NPI:1558444513
Name:LAWRENCE REHABILITATION SPECIALISTS , INC
Entity Type:Organization
Organization Name:LAWRENCE REHABILITATION SPECIALISTS , INC
Other - Org Name:LAWRENCE REHABILITATION - THE GAIT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:804-523-2653
Mailing Address - Street 1:8191 STAPLES MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2751
Mailing Address - Country:US
Mailing Address - Phone:804-523-2653
Mailing Address - Fax:804-767-4415
Practice Address - Street 1:8191 STAPLES MILL ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2751
Practice Address - Country:US
Practice Address - Phone:804-523-2653
Practice Address - Fax:804-767-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003976261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10075Medicare PIN