Provider Demographics
NPI:1588138853
Name:BOATMAN, LAWRENCE (LMT, PTA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BOATMAN
Suffix:
Gender:M
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 STERLING ST APT 201
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4066
Mailing Address - Country:US
Mailing Address - Phone:704-491-0462
Mailing Address - Fax:
Practice Address - Street 1:3975 STATE HIGHWAY 6 S STE 700
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5899
Practice Address - Country:US
Practice Address - Phone:979-696-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2076213225200000X
TX114500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant