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General NPI Number Information
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NPI Number | 1851934566
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Entity Type | Individual
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Provider Name | LOSHEILAH LAWRENCE PT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 101 JUMPERS RUN
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1507
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Country | US
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Telephone | 803-609-5159
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Fax | 855-232-8604
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Provider Business Mailing Address
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Address Line | 101 JUMPERS RUN
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1507
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Country | US
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Telephone | 803-609-5159
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Fax | 855-232-8604
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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 | 4108
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License Number State | SC
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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 | PT011431
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License Number State | GA
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