MEDICARE: SARAH LAWLESS PT, DPT

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	046376	NY

General Provider Information

NPI Number	:	1164038246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LAWLESS PT, DPT

Provider Business Mailing Address
First Line	:	107 SMITH ST APT 1R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5740
Country	:	US
Telephone Number	:	585-645-3522
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4206
Country	:	US
Telephone Number	:	718-855-1543
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	01/07/2021

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