MEDICARE: COTREASE LAWSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6088	SC

General Provider Information

NPI Number	:	1043584980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COTREASE LAWSON

Provider Business Mailing Address
First Line	:	16405 NORTHCROSS DR
Second Line	:	STE G-2
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5091
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16405 NORTHCROSS DR
Second Line	:	STE G-2
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5091
Country	:	US
Telephone Number	:	704-439-3403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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