Provider Demographics
NPI:1952605750
Name:LAWSON, BRAD ALAN (LMT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:ALAN
Last Name:LAWSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 S CARSON AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4666
Mailing Address - Country:US
Mailing Address - Phone:918-587-7111
Mailing Address - Fax:918-587-1177
Practice Address - Street 1:1722 S CARSON AVE
Practice Address - Street 2:SUITE 3100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4666
Practice Address - Country:US
Practice Address - Phone:918-587-7111
Practice Address - Fax:918-587-1177
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK081152415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist