Provider Demographics
NPI:1801125588
Name:MICHAELSON, LAWRENCE B (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:B
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E MCKELLIPS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2721
Mailing Address - Country:US
Mailing Address - Phone:480-827-0495
Mailing Address - Fax:480-827-2534
Practice Address - Street 1:1345 E MCKELLIPS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2721
Practice Address - Country:US
Practice Address - Phone:480-827-0495
Practice Address - Fax:480-827-2534
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic