Provider Demographics
NPI:1194973834
Name:LAU, BRIAN SCOTT (AP DOM LMT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:LAU
Suffix:
Gender:M
Credentials:AP DOM LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9613 N 55TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4723
Mailing Address - Country:US
Mailing Address - Phone:813-766-1319
Mailing Address - Fax:888-440-0629
Practice Address - Street 1:10927 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3000
Practice Address - Country:US
Practice Address - Phone:813-766-1319
Practice Address - Fax:888-440-0629
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30879225700000X
FL3036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist