Provider Demographics
NPI:1083666499
Name:CALOIA, LORI DANAE (PT ATC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:DANAE
Last Name:CALOIA
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:LOR
Other - Middle Name:DANAE
Other - Last Name:BROCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6118
Mailing Address - Country:US
Mailing Address - Phone:248-853-4431
Mailing Address - Fax:248-853-5048
Practice Address - Street 1:1701 SOUTH BLVD E STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6118
Practice Address - Country:US
Practice Address - Phone:248-853-4431
Practice Address - Fax:248-853-5048
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
236613Medicare ID - Type Unspecified