Provider Demographics
NPI:1730763954
Name:LAWRENCE, PRIYAL SCOTT (PT)
Entity type:Individual
Prefix:
First Name:PRIYAL
Middle Name:SCOTT
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6034
Mailing Address - Country:US
Mailing Address - Phone:540-314-6421
Mailing Address - Fax:
Practice Address - Street 1:4419 PHEASANT RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5267
Practice Address - Country:US
Practice Address - Phone:540-278-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046170-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist