Provider Demographics
NPI:1245276013
Name:LAWRENCE, MARSHA B (PT, CHT)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:B
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18540 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9450
Mailing Address - Country:US
Mailing Address - Phone:913-209-9558
Mailing Address - Fax:913-402-1906
Practice Address - Street 1:18540 METCALF AVE
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-9450
Practice Address - Country:US
Practice Address - Phone:913-209-9558
Practice Address - Fax:913-402-1906
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11031032251H1200X
MO20020173982251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33424033OtherBLUE SHIELD OF KANSAS CIT
MO33424033OtherBLUE SHIELD OF KANSAS CIT