Provider Demographics
NPI:1295106417
Name:LAWRENCE, DANIEL RAY (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RAY
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 DOVERVILLE CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4401
Mailing Address - Country:US
Mailing Address - Phone:770-367-6712
Mailing Address - Fax:
Practice Address - Street 1:1101 DOVERVILLE CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4401
Practice Address - Country:US
Practice Address - Phone:770-367-6712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-27582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer