Provider Demographics
NPI:1083030209
Name:STRAW, LOWELL (PT)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:
Last Name:STRAW
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 1:1501 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2134
Mailing Address - Country:US
Mailing Address - Phone:765-423-6885
Mailing Address - Fax:765-423-6099
Practice Address - Street 1:1260 N 17TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2163
Practice Address - Country:US
Practice Address - Phone:765-423-6885
Practice Address - Fax:765-423-6099
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001300A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic