Provider Demographics
NPI:1992386965
Name:STRAWDER, PRENTICE LAMAR JR
Entity Type:Individual
Prefix:
First Name:PRENTICE
Middle Name:LAMAR
Last Name:STRAWDER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 GROVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1585
Mailing Address - Country:US
Mailing Address - Phone:706-507-4460
Mailing Address - Fax:
Practice Address - Street 1:1479 GROVE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-1585
Practice Address - Country:US
Practice Address - Phone:706-507-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist