Provider Demographics
NPI:1932223310
Name:LAWRENCE, PAULA DENISE (PT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:DENISE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43725 MANDARIN DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8529
Mailing Address - Country:US
Mailing Address - Phone:951-927-7507
Mailing Address - Fax:951-927-7507
Practice Address - Street 1:4000 E FLORIDA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-5098
Practice Address - Country:US
Practice Address - Phone:951-652-1111
Practice Address - Fax:951-658-5438
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT150541Medicare ID - Type Unspecified