MEDICARE: CASSIE LAWRENCE PTA

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	PT017888	GA

General Provider Information

NPI Number	:	1790177426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE LAWRENCE PTA

Provider Business Mailing Address
First Line	:	966A KILLIAN HILL RD SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3102
Country	:	US
Telephone Number	:	706-442-0523
Fax Number	:

Provider Business Practice Location Address
First Line	:	966A KILLIAN HILL RD SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3102
Country	:	US
Telephone Number	:	706-442-0523
Fax Number	:

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

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	03/04/2026

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Directions to “ CASSIE LAWRENCE PTA” Practice Location

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