Basic Information
Provider Information
NPI: 1306568225
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANCHEZ
FirstName: LAWRENCE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 703 GRANITE ST STE 300
Address2:  
City: BRAINTREE
State: MA
PostalCode: 021845350
CountryCode: US
TelephoneNumber: 7818076138
FaxNumber:  
Practice Location
Address1: 26 S MAIN ST
Address2:  
City: RANDOLPH
State: MA
PostalCode: 023684821
CountryCode: US
TelephoneNumber: 7819619200
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2022
LastUpdateDate: 09/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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