Provider Demographics
NPI:1083673354
Name:LAWRENCE, AMBER DAWN (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11008 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4493
Mailing Address - Country:US
Mailing Address - Phone:402-779-9238
Mailing Address - Fax:
Practice Address - Street 1:6902 PINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2855
Practice Address - Country:US
Practice Address - Phone:402-559-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2556225100000X
NE2391225100000X
VA2305208453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305208453OtherPHYSICAL THERAPIST LICENSE
HI2556OtherPHYSICAL THERAPIST LICENSE - INACTIVE
NE2391OtherPHYSICAL THERAPIST LICENSE - INACTIVE