Provider Demographics
NPI:1770940108
Name:LAWRENCE, MICHELLE ANNA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BEM CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066
Mailing Address - Country:US
Mailing Address - Phone:573-690-8107
Mailing Address - Fax:
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 106
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5230
Practice Address - Country:US
Practice Address - Phone:907-563-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015044700225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist