Provider Demographics
NPI:1760861504
Name:LAWRENCE, SHAWN M (LMP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17528 MERIDIAN E
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-4902
Mailing Address - Country:US
Mailing Address - Phone:253-445-9030
Mailing Address - Fax:253-445-9031
Practice Address - Street 1:5216 72ND ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98443-2722
Practice Address - Country:US
Practice Address - Phone:253-537-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60503864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist