MEDICARE: MS. JENNA LAWLESS MPT

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	1160293	TX

General Provider Information

NPI Number	:	1730215583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNA LAWLESS MPT

Provider Business Mailing Address
First Line	:	340 CAPELLA OAKS LN
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-4382
Country	:	US
Telephone Number	:	413-519-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	18100 SAINT JOHN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3631
Country	:	US
Telephone Number	:	281-333-8806
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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