Provider Demographics
NPI:1639735707
Name:LAWRENCE, ERICA LANE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LANE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LANE
Other - Last Name:EAGLEBURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:14802 SHAMROCK WAY STE C
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-8381
Practice Address - Country:US
Practice Address - Phone:816-873-1101
Practice Address - Fax:816-399-5796
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019904225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist