Provider Demographics
NPI:1013179555
Name:ANDERSON, LORI M (PT-MS)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT-MS
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:M
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:4305 LARRY DON LN
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-5852
Mailing Address - Country:US
Mailing Address - Phone:254-405-3715
Mailing Address - Fax:
Practice Address - Street 1:6600 FISH POND RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2581
Practice Address - Country:US
Practice Address - Phone:254-741-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11685062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic