Provider Demographics
NPI:1861629719
Name:LAWRENCE, CHARLETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:CHARLETTE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ANNAPOLIS RD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2060
Mailing Address - Country:US
Mailing Address - Phone:301-577-4333
Mailing Address - Fax:301-577-5180
Practice Address - Street 1:9500 ANNAPOLIS RD
Practice Address - Street 2:SUITE C4
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2060
Practice Address - Country:US
Practice Address - Phone:301-577-4333
Practice Address - Fax:301-577-5180
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPT768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist