Provider Demographics
NPI:1881102259
Name:BEARDSLEY, LAWRIE SUMNER (PT)
Entity type:Individual
Prefix:MRS
First Name:LAWRIE
Middle Name:SUMNER
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 HOLGATE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2836
Mailing Address - Country:US
Mailing Address - Phone:336-327-3625
Mailing Address - Fax:
Practice Address - Street 1:3723 W MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1375
Practice Address - Country:US
Practice Address - Phone:336-299-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist