Provider Demographics
NPI:1902889785
Name:LAWRENCE, GARY W (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 SOBRANTE WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-4807
Mailing Address - Country:US
Mailing Address - Phone:408-733-3670
Mailing Address - Fax:408-245-7968
Practice Address - Street 1:2039 FOREST AVE
Practice Address - Street 2:STE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4817
Practice Address - Country:US
Practice Address - Phone:408-279-8501
Practice Address - Fax:408-279-8504
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEO607ZMedicare PIN