Lawrence Marvin Tierce, PT

Key facts

NPI

1508336504

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

PT239 (MS)

Practice address

512 Rockwell Dr
Okolona, MS 38860-1622

Phone

(662) 447-5777

Fax

(601) 607-1381

NPI assigned

Dec 3, 2018

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 3, 2018.

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543795200000",
    "number": "1508336504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 AVIGNON DR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391575120",
            "telephone_number": "601-605-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 ROCKWELL DR",
            "city": "OKOLONA",
            "state": "MS",
            "postal_code": "388601622",
            "telephone_number": "662-447-5777",
            "fax_number": "601-607-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIERCE",
        "first_name": "LAWRENCE",
        "middle_name": "MARVIN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-03",
        "last_updated": "2018-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Okolona, MS · Physical Therapist in Mississippi