Provider Demographics
NPI:1730215583
Name:LAWLESS, JENNA (MPT)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CAPELLA OAKS LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4382
Mailing Address - Country:US
Mailing Address - Phone:413-519-9292
Mailing Address - Fax:
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:281-333-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist