=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255501615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE E. HEARN M.A., P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2008
-----------------------------------------------------
Last Update Date | 03/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 WYANDOTTE AVE
-----------------------------------------------------
City | OROVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95966-6539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-532-5696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1980 BRIARWOOD CT
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-1276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-751-7426
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT7352
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------