Healthcare Provider Details

I. General information

NPI: 1194973834
Provider Name (Legal Business Name): BRIAN SCOTT LAU AP DOM LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10927 N 56TH ST
TEMPLE TERRACE FL
33617-3000
US

IV. Provider business mailing address

9613 N 55TH ST
TEMPLE TERRACE FL
33617-4723
US

V. Phone/Fax

Practice location:
  • Phone: 813-766-1319
  • Fax: 888-440-0629
Mailing address:
  • Phone: 813-766-1319
  • Fax: 888-440-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3036
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA30879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: