Provider Demographics
NPI:1447872585
Name:LAWRENCE, DENISE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11509 NE SYLVAN TER
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4132
Mailing Address - Country:US
Mailing Address - Phone:831-601-9628
Mailing Address - Fax:
Practice Address - Street 1:13317 NE 12TH AVE STE 115A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2731
Practice Address - Country:US
Practice Address - Phone:360-726-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61052874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist