Provider Demographics
NPI:1023305711
Name:LAWRENCE, RON JANUEL (RPT)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:JANUEL
Last Name:LAWRENCE
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Gender:M
Credentials:RPT
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Mailing Address - Street 1:555 S MISSION ST
Mailing Address - Street 2:SUITE # B
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2846
Mailing Address - Country:US
Mailing Address - Phone:989-772-7755
Mailing Address - Fax:989-772-7750
Practice Address - Street 1:5511 W US HIGHWAY 10
Practice Address - Street 2:SUITE B
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2455
Practice Address - Country:US
Practice Address - Phone:989-772-7755
Practice Address - Fax:989-772-7750
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
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Provider Licenses
StateLicense IDTaxonomies
MI5501015582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015582OtherSTATE OF MI