MEDICARE: MRS. BRIANNA SHANNIE 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	2305210836	VA

General Provider Information

NPI Number	:	1790225589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIANNA SHANNIE LAWLESS PT, DPT

Provider Business Mailing Address
First Line	:	1906 MILLER AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-4923
Country	:	US
Telephone Number	:	304-320-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 MILLER AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-4923
Country	:	US
Telephone Number	:	304-320-7009
Fax Number	:

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

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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