Provider Demographics
NPI:1790225589
Name:LAWLESS, BRIANNA SHANNIE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:SHANNIE
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1906 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4923
Mailing Address - Country:US
Mailing Address - Phone:304-320-7009
Mailing Address - Fax:
Practice Address - Street 1:1906 MILLER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4923
Practice Address - Country:US
Practice Address - Phone:304-320-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist