Provider Demographics
NPI:1477788339
Name:LAWSON, CARROLL M (DPT)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:M
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W LUGONIA AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9703
Mailing Address - Country:US
Mailing Address - Phone:909-557-1604
Mailing Address - Fax:909-557-1732
Practice Address - Street 1:1901 W LUGONIA AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-9703
Practice Address - Country:US
Practice Address - Phone:909-557-1604
Practice Address - Fax:909-557-1732
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist