Provider Demographics
NPI:1851738272
Name:LAWR, DEREK SCOTT (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:SCOTT
Last Name:LAWR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16126 SE HAPPY VALLEY TOWN CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4256
Mailing Address - Country:US
Mailing Address - Phone:503-427-0118
Mailing Address - Fax:503-427-0279
Practice Address - Street 1:16126 SE HAPPY VALLEY TOWN CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4256
Practice Address - Country:US
Practice Address - Phone:503-427-0118
Practice Address - Fax:503-427-0279
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01322045OtherRR
OR500660005Medicaid
OR500660005Medicaid