MEDICARE: DR. BLAISE ANTHONY LAWSON 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	40QA02392200	NJ

General Provider Information

NPI Number	:	1689531493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAISE ANTHONY LAWSON DPT

Provider Business Mailing Address
First Line	:	8226 VILLA LAGO DR APT 1028
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-2261
Country	:	US
Telephone Number	:	732-684-8377
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 W BAILEY BOSWELL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4327
Country	:	US
Telephone Number	:	972-979-6577
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ DR. BLAISE ANTHONY LAWSON DPT” Practice Location

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