Provider Demographics
NPI:1588157515
Name:LAWVER, MITCHELL (DPT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:LAWVER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-9116
Mailing Address - Country:US
Mailing Address - Phone:608-886-0211
Mailing Address - Fax:
Practice Address - Street 1:610 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1269
Practice Address - Country:US
Practice Address - Phone:541-963-1437
Practice Address - Fax:541-963-1890
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
OR62694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist