Provider Demographics
NPI:1477030195
Name:LAWSON, JACIE DAWN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACIE
Middle Name:DAWN
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JACIE
Other - Middle Name:DAWN
Other - Last Name:TARNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1136 E GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3982
Mailing Address - Country:US
Mailing Address - Phone:903-592-5601
Mailing Address - Fax:
Practice Address - Street 1:921 SHILOH RD STE C120
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1407
Practice Address - Country:US
Practice Address - Phone:903-939-2800
Practice Address - Fax:866-386-4531
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1271607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist