Provider Demographics
NPI:1962678326
Name:LAWRENCE, DANIELLE MARICIA (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARICIA
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 1:2103 NILES CORTLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3067
Mailing Address - Country:US
Mailing Address - Phone:330-544-3737
Mailing Address - Fax:330-544-3904
Practice Address - Street 1:2103 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3067
Practice Address - Country:US
Practice Address - Phone:330-544-3737
Practice Address - Fax:330-544-3904
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist