Provider Demographics
NPI:1154535078
Name:JAFFE, LAWRENCE ERIC (PT, SCS, ATC)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ERIC
Last Name:JAFFE
Suffix:
Gender:M
Credentials:PT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 NW 75TH PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3942
Mailing Address - Country:US
Mailing Address - Phone:954-740-1720
Mailing Address - Fax:954-757-2242
Practice Address - Street 1:7410 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE A-11
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6156
Practice Address - Country:US
Practice Address - Phone:561-731-0163
Practice Address - Fax:561-731-1886
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22266225100000X, 2251S0007X
FLAL21212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports