Provider Demographics
NPI:1346310026
Name:FOSSITT, LAWRENCE ALLEN (MPT, CFMT)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:FOSSITT
Suffix:
Gender:M
Credentials:MPT, CFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BRASSINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713
Mailing Address - Country:US
Mailing Address - Phone:407-792-8590
Mailing Address - Fax:407-328-5430
Practice Address - Street 1:2015 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3361
Practice Address - Country:US
Practice Address - Phone:407-328-5420
Practice Address - Fax:407-328-5430
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19048OtherPROFESSIONAL LICENSE NUM.
FLY045ROtherBCBSFL NUMBER
FLPT19048OtherPROFESSIONAL LICENSE NUM.