Provider Demographics
NPI:1114397403
Name:WHITLEY, LORI (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEARTHSTONE CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3065
Mailing Address - Country:US
Mailing Address - Phone:610-685-1761
Mailing Address - Fax:
Practice Address - Street 1:6 HEARTHSTONE CT
Practice Address - Street 2:SUITE 106
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3065
Practice Address - Country:US
Practice Address - Phone:610-685-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005545225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist