Provider Demographics
NPI:1427264357
Name:LLEWELLYN, LAWRENCE EDWARD JR
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:LLEWELLYN
Suffix:JR
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 1:17920 E MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9570
Mailing Address - Country:US
Mailing Address - Phone:208-651-3177
Mailing Address - Fax:
Practice Address - Street 1:2001 BRYAN ST
Practice Address - Street 2:SUITE 3090
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3002
Practice Address - Country:US
Practice Address - Phone:509-765-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant