Provider Demographics
NPI:1477547156
Name:LAWSHE, BRANDON (PT, ATC, LAT, PES)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:LAWSHE
Suffix:
Gender:M
Credentials:PT, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 IRA E WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3930
Mailing Address - Country:US
Mailing Address - Phone:817-581-3400
Mailing Address - Fax:
Practice Address - Street 1:2535 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3930
Practice Address - Country:US
Practice Address - Phone:817-581-3400
Practice Address - Fax:817-421-0908
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1147057225100000X
TXAT15752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer