Provider Demographics
NPI:1851934566
Name:LAWRENCE, LOSHEILAH (PT)
Entity Type:Individual
Prefix:
First Name:LOSHEILAH
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JUMPERS RUN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1507
Mailing Address - Country:US
Mailing Address - Phone:803-609-5159
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:101 JUMPERS RUN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1507
Practice Address - Country:US
Practice Address - Phone:803-609-5159
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4108225100000X
GAPT011431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist