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NPI Code Detail

MEDICARE: SCOTT E LAWRANCE MS PT

MEDICARE: SCOTT E LAWRANCE MS PT
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
1225100000XPhysical Therapist05008318AIN
22255A2300XAthletic Trainer36000633AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DB9030OTHERGARAILROAD MEDICARE GROUP NUMBER
2P00479057OTHERGARAILROAD MEDICARE PTAN

General Provider Information

NPI Number : 1417954637
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT E LAWRANCE MS PT
Provider Business Mailing Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3630
Country : US
Telephone Number : 317-788-3248
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3630
Country : US
Telephone Number : 317-788-3248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 09/18/2014

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Directions to “ SCOTT E LAWRANCE MS PT” Practice Location

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