Provider Demographics
NPI:1942506068
Name:SIEGEL, LAWRENCE MITCHELL
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MITCHELL
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 ROUNDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0600
Mailing Address - Country:US
Mailing Address - Phone:775-448-6570
Mailing Address - Fax:
Practice Address - Street 1:4356 ROUNDSTONE DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-0600
Practice Address - Country:US
Practice Address - Phone:775-448-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner