Provider Demographics
NPI:1326462201
Name:LAWSON, FONNIE GAYLE (PT)
Entity Type:Individual
Prefix:
First Name:FONNIE
Middle Name:GAYLE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:FONNIE
Other - Middle Name:GAYLE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2465 LITTLE DRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3250
Mailing Address - Country:US
Mailing Address - Phone:513-231-3240
Mailing Address - Fax:513-231-3202
Practice Address - Street 1:2465 LITTLE DRY RUN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-3250
Practice Address - Country:US
Practice Address - Phone:513-231-3240
Practice Address - Fax:513-231-3202
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-9399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist