Provider Demographics
NPI:1073280855
Name:ROBERTS, LAWSON
Entity Type:Individual
Prefix:
First Name:LAWSON
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 OLD FULTON RD # APPTB1
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-1847
Mailing Address - Country:US
Mailing Address - Phone:731-415-6058
Mailing Address - Fax:
Practice Address - Street 1:1105 S SUNSWEPT ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-4370
Practice Address - Country:US
Practice Address - Phone:731-885-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant