Provider Demographics
NPI:1568457760
Name:PEARSON, LANCE ERIC (PT, CO)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:ERIC
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PT, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 13TH PL S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-6604
Mailing Address - Country:US
Mailing Address - Phone:205-908-3775
Mailing Address - Fax:205-933-6617
Practice Address - Street 1:1425 21ST ST S
Practice Address - Street 2:SUITE 104
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3898
Practice Address - Country:US
Practice Address - Phone:205-933-9582
Practice Address - Fax:205-933-6617
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL128222Z00000X
ALPTH1624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL128OtherORTHOTIST LIC #, AL
ALPTH1624OtherPT STATE LICENSE #
AL128OtherORTHOTIST LIC #, AL