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:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22266225100000X, 2251S0007X
FLAL21212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer