Provider Demographics
NPI:1265120620
Name:MCLAWRENCE, MOLLY (PTA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MCLAWRENCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19604 SMITH GIN ST
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4069
Mailing Address - Country:US
Mailing Address - Phone:585-331-1516
Mailing Address - Fax:
Practice Address - Street 1:19604 SMITH GIN ST
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-4069
Practice Address - Country:US
Practice Address - Phone:585-331-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2164089225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant