Provider Demographics
NPI:1760675805
Name:LAWRENCE, ANDREW C (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:C
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-1005
Mailing Address - Country:US
Mailing Address - Phone:912-375-2009
Mailing Address - Fax:912-379-0081
Practice Address - Street 1:124 E JARMAN ST STE B
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6133
Practice Address - Country:US
Practice Address - Phone:912-375-2009
Practice Address - Fax:912-379-0081
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001434225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant