Provider Demographics
NPI:1114060563
Name:CHOQUETTE, LORI BEIDL (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BEIDL
Last Name:CHOQUETTE
Suffix:
Gender:F
Credentials:PTA
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 312
Mailing Address - Street 2:
Mailing Address - City:POSEYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47633-0312
Mailing Address - Country:US
Mailing Address - Phone:812-484-9310
Mailing Address - Fax:
Practice Address - Street 1:4000 TULIP TREE DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-2300
Practice Address - Country:US
Practice Address - Phone:812-387-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002560A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant