Provider Demographics
NPI:1891183653
Name:LAWSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LAWSON PHYSICAL THERAPY
Other - Org Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:REID
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:912-256-0113
Mailing Address - Street 1:397 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31546-3645
Mailing Address - Country:US
Mailing Address - Phone:912-256-0113
Mailing Address - Fax:
Practice Address - Street 1:1579 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0611
Practice Address - Country:US
Practice Address - Phone:912-256-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QP2000X261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy