Provider Demographics
NPI:1871005652
Name:LAWRENCE, KRISTIAN DANIELLE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:DANIELLE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 LYNWAY LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3009
Mailing Address - Country:US
Mailing Address - Phone:229-376-0953
Mailing Address - Fax:
Practice Address - Street 1:2562 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1461
Practice Address - Country:US
Practice Address - Phone:404-423-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist