Provider Demographics
NPI:1134102981
Name:FALKEL, LORI F (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:F
Last Name:FALKEL
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 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-501-3750
Mailing Address - Fax:
Practice Address - Street 1:852 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2406
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3023225100000X
WAPT60074918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ748329Medicaid
AZ650026167OtherRAILROAD MEDICARE
OR500612011Medicaid
WA8542243Medicaid
WA0248516OtherLABOR & INDUSTRIES
WAP00726422OtherRAILROAD MEDICARE
AZ748329Medicaid
WA8542243Medicaid
AZZ72981Medicare PIN