Provider Demographics
NPI:1578729158
Name:LAWRENCE, STACEY L (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:DONUHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:58
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6719
Mailing Address - Country:US
Mailing Address - Phone:603-626-4205
Mailing Address - Fax:
Practice Address - Street 1:40 S RIVER RD
Practice Address - Street 2:58
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6719
Practice Address - Country:US
Practice Address - Phone:603-626-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist