Healthcare Provider Details

I. General information

NPI: 1508876020
Provider Name (Legal Business Name): DARYL JAY LAWSON PT, DPTSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WMU UNIFIED CLINICS 1000 OAKLAND DR FL 3
KALAMAZOO MI
49008
US

IV. Provider business mailing address

WMU UNIFIED CLINICS 1000 OAKLAND DR FL 3
KALAMAZOO MI
49008
US

V. Phone/Fax

Practice location:
  • Phone: 269-387-7000
  • Fax: 269-387-7026
Mailing address:
  • Phone: 269-387-7000
  • Fax: 269-387-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0710
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: