Provider Demographics
NPI:1134451180
Name:LAWRENCE, BRIAN (LMT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SAINT LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4316
Mailing Address - Country:US
Mailing Address - Phone:207-318-1254
Mailing Address - Fax:
Practice Address - Street 1:16 SAINT LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4316
Practice Address - Country:US
Practice Address - Phone:207-318-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist