Provider Demographics
NPI:1740414192
Name:LAWSON, JODI L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:LAWSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HAWK CT
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-3205
Mailing Address - Country:US
Mailing Address - Phone:850-559-0080
Mailing Address - Fax:
Practice Address - Street 1:3521 MACLAY BLVD S
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3913
Practice Address - Country:US
Practice Address - Phone:850-559-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC9108OtherBCBSFL