Provider Demographics
NPI:1053403592
Name:CHEAL, LAWRENCE R (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:CHEAL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4526
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4526
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271046Medicaid
OR930635514OtherGROUP TAX ID
OR161133OtherNBMC GROUP MEDICAID
ORR0000WFBTVOtherGROUP MEDICARE
OR1407812365OtherGROUP NPI
OR1407812365OtherGROUP NPI