Healthcare Provider Details

I. General information

NPI: 1013013861
Provider Name (Legal Business Name): LAWRENCE ERIC LINGREN M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/13/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S GALLAHER VIEW RD STE 105
KNOXVILLE TN
37919-5302
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 865-328-7370
  • Fax:
Mailing address:
  • Phone: 714-227-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number23775
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14574
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: