Provider Demographics
NPI:1114984036
Name:FIERRO, LORRAINE (MSPT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:FIERRO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 ROUTE 206 SOUTH
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9199
Mailing Address - Country:US
Mailing Address - Phone:973-598-3077
Mailing Address - Fax:973-598-3097
Practice Address - Street 1:244 ROUTE 206 SOUTH
Practice Address - Street 2:SUITE 3
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9199
Practice Address - Country:US
Practice Address - Phone:973-598-3077
Practice Address - Fax:973-598-3097
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01084500225100000X
FLPT26789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist