Healthcare Provider Details

I. General information

NPI: 1477547156
Provider Name (Legal Business Name): BRANDON LAWSHE PT, ATC, LAT, PES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 IRA E WOODS AVE
GRAPEVINE TX
76051-3930
US

IV. Provider business mailing address

2535 IRA E WOODS AVE
GRAPEVINE TX
76051-3930
US

V. Phone/Fax

Practice location:
  • Phone: 817-581-3400
  • Fax: 817-421-0908
Mailing address:
  • Phone: 817-581-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1147057
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: