Provider Demographics
NPI:1033295043
Name:MYERS, LORI K (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2232
Mailing Address - Street 2:280 ZEREX ST.
Mailing Address - City:FRASER
Mailing Address - State:CO
Mailing Address - Zip Code:80442-2232
Mailing Address - Country:US
Mailing Address - Phone:970-722-1060
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:970-722-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01403688Medicaid
CO01403688Medicaid