Provider Demographics
NPI:1982184537
Name:LAWRENCE, BRIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 BARDSTOWN RD STE 100C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3263
Mailing Address - Country:US
Mailing Address - Phone:502-493-3800
Mailing Address - Fax:502-493-3830
Practice Address - Street 1:4233 BARDSTOWN RD STE 100C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3263
Practice Address - Country:US
Practice Address - Phone:502-493-3800
Practice Address - Fax:502-493-3830
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY007442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist