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General NPI Number Information
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NPI Number | 1689531493
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Entity Type | Individual
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Provider Name | BLAISE ANTHONY LAWSON DPT
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Gender | Male
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 4617 W BAILEY BOSWELL RD
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City | FORT WORTH
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State | TX
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Zip | 76179-4327
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Country | US
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Telephone | 972-979-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 8226 VILLA LAGO DR APT 1028
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City | FORT WORTH
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State | TX
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Zip | 76179-2261
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Country | US
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Telephone | 732-684-8377
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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 | 40QA02392200
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License Number State | NJ
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