Provider Demographics
NPI:1184753576
Name:LAWRENCE, MARIE C (PT, DPT, ATC)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:C
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 MISSOURI AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5111
Mailing Address - Country:US
Mailing Address - Phone:575-523-8080
Mailing Address - Fax:
Practice Address - Street 1:2445 MISSOURI AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5111
Practice Address - Country:US
Practice Address - Phone:575-523-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist