Provider Demographics
NPI:1558612135
Name:LAWALL P & O OF FLORIDA, INC.
Entity Type:Organization
Organization Name:LAWALL P & O OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAWALL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:215-338-6611
Mailing Address - Street 1:3000 CABOT BLVD W
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1800
Mailing Address - Country:US
Mailing Address - Phone:215-338-6611
Mailing Address - Fax:215-338-9579
Practice Address - Street 1:6535 NEMOURS PARKWAY
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-855-4801
Practice Address - Fax:407-855-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006699600Medicaid
FL006699600Medicaid