Provider Demographics
NPI:1386987105
Name:LAWRENCE, CHRISTOPHER DALE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166 COUNTY ROAD 1320
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015-2270
Mailing Address - Country:US
Mailing Address - Phone:580-284-8853
Mailing Address - Fax:580-569-2075
Practice Address - Street 1:4166 COUNTY ROAD 1320
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015-2270
Practice Address - Country:US
Practice Address - Phone:580-284-8853
Practice Address - Fax:580-569-2075
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1236225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant