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General NPI Number Information
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NPI Number | 1215415450
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Entity Type | Individual
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Provider Name | LAWRENCE REYNOLDS ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1115 EAST GETWELL LOOP BILL JMURPHY FOOTBALL COMPLEX
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City | MEMPHIS
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State | TN
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Zip | 38152-0001
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Country | US
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Telephone | 901-678-5384
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Fax |
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Provider Business Mailing Address
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Address Line | 573 ARBOR HOLLOW CIR APT 208
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City | CORDOVA
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State | TN
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Zip | 38018-8096
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Country | US
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Telephone | 513-405-4154
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1782
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License Number State | TN
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