=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831317015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY LYNN SCHMIDT-LAWSON DPT, MTC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CYPRESS POINT PKWY STE 106
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-264-6672
-----------------------------------------------------
Fax | 386-264-6632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 PORCUPINE DR
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-6737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-642-0298
-----------------------------------------------------
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 | PT22431
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------