Provider Demographics
NPI:1902206964
Name:TATEM, LAWRENCE I (PT)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:TATEM
Suffix:I
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5716
Mailing Address - Country:US
Mailing Address - Phone:718-739-3206
Mailing Address - Fax:718-739-3207
Practice Address - Street 1:11024 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5716
Practice Address - Country:US
Practice Address - Phone:718-739-3206
Practice Address - Fax:718-739-3207
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist