Provider Demographics
NPI:1215415450
Name:REYNOLDS, LAWRENCE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 ARBOR HOLLOW CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8096
Mailing Address - Country:US
Mailing Address - Phone:513-405-4154
Mailing Address - Fax:
Practice Address - Street 1:1115 EAST GETWELL LOOP BILL JMURPHY FOOTBALL COMPLEX
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-0001
Practice Address - Country:US
Practice Address - Phone:901-678-5384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer