Provider Demographics
NPI:1750530580
Name:LAWRENCE, KATHLEEN ANNA (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNA
Last Name:LAWRENCE
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANNA
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14417 ADAIR MANOR CT,
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-641-6610
Mailing Address - Fax:610-335-4369
Practice Address - Street 1:3800 SHAMROCK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215
Practice Address - Country:US
Practice Address - Phone:704-532-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10622225100000X
NC8159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist