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General NPI Number Information
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NPI Number | 1104431972
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Entity Type | Individual
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Provider Name | WESLEY LAWLESS DPT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 1861 WESTEN ST STE B
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City | BOWLING GREEN
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State | KY
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Zip | 42104-4151
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Country | US
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Telephone | 270-904-2753
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Fax | 270-904-4680
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-8923
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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