Provider Demographics
NPI:1902205891
Name:LAWRENCE, SAMANTHA GUARRERA (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GUARRERA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:GUARRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1398 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-8763
Mailing Address - Country:US
Mailing Address - Phone:315-510-3372
Mailing Address - Fax:315-510-3688
Practice Address - Street 1:1398 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8763
Practice Address - Country:US
Practice Address - Phone:315-510-3372
Practice Address - Fax:315-510-3688
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist