Provider Demographics
NPI:1205349354
Name:LAWSON, KENYA LATRICE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:KENYA
Middle Name:LATRICE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2921
Mailing Address - Country:US
Mailing Address - Phone:321-262-1796
Mailing Address - Fax:
Practice Address - Street 1:1700 3RD ST NE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2264
Practice Address - Country:US
Practice Address - Phone:319-334-7015
Practice Address - Fax:319-334-7016
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225100000X
FLPT33180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist