1205292562 NPI number — JEFFREY RYAN LAWSON DPT, CSCS, FNS

Table of content: JEFFREY RYAN LAWSON DPT, CSCS, FNS (NPI 1205292562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205292562 NPI number — JEFFREY RYAN LAWSON DPT, CSCS, FNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWSON
Provider First Name:
JEFFREY
Provider Middle Name:
RYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, CSCS, FNS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205292562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 BIRCHWOOD RD
Provider Second Line Business Mailing Address:
APARTMENT B
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04039-9738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-253-9348
Provider Business Mailing Address Fax Number:
207-373-0908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 TOPSHAM FAIR MALL RD
Provider Second Line Business Practice Location Address:
SUITE 25
Provider Business Practice Location Address City Name:
TOPSHAM
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04086-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-253-9348
Provider Business Practice Location Address Fax Number:
207-373-0908
Provider Enumeration Date:
01/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT4269 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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