Provider Demographics
NPI:1134510779
Name:RABER, LORI ANN (ATC, PTA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:RABER
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:UPPERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, PTA
Mailing Address - Street 1:12555 LAKEWOOD BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2771
Mailing Address - Country:US
Mailing Address - Phone:562-923-4704
Mailing Address - Fax:
Practice Address - Street 1:12555 LAKEWOOD BLVD STE F
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2771
Practice Address - Country:US
Practice Address - Phone:562-923-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 2525225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant