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General NPI Number Information
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NPI Number | 1225335185
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Entity Type | Organization
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Legal Business Name | TRIKARE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 3210 WHELDON WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3107
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Country | US
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Telephone | 678-467-7368
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 WHELDON WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3107
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Country | US
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Telephone | 678-467-7368
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KARLTON LAMAR LAWRENCE
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Credential | PT, DPT, MSR
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Telephone | 678-467-7368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP005137
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT007278
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License Number State | GA
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