Lawrence Robert Wade

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-17645 Issued in FL

Practice address

3456 21St Ave S
St Petersburg, FL 33711-3213

Phone

(727) 327-1988

NPI assigned

Jul 22, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1972176329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5034 3RD AVE N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337108212",
            "telephone_number": "727-288-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3456 21ST AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337113213",
            "telephone_number": "727-327-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "LAWRENCE",
        "middle_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA-17645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "facility",
            "affiliation": "N",
            "address_1": "3456 21st Ave S",
            "city": "St Petersburg",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337113213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Georgene Vukelich, CRNA
• Ashley Wade
• Brianne L. Wade, DMD
• Brittany Wade, PHD
• Gwendolyn Wade, B.S.
• Hemant Wadhwani, M.D.
• Victoria Waechter, APRN
• Casey Waggett
• Kimberly Ann Wagner-Rohrs, LCSW
• Anastasia Wagner

• Physical Therapy Assistant in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.