Provider Demographics
NPI:1619549607
Name:LAWRANCE, BRADLEY J (PTA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:LAWRANCE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2169
Mailing Address - Country:US
Mailing Address - Phone:954-554-3962
Mailing Address - Fax:
Practice Address - Street 1:216 FAIRGROUND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3531
Practice Address - Country:US
Practice Address - Phone:615-790-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7582208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7582Medicaid