Provider Demographics
NPI:1164615621
Name:MARTIN, LORRI LEE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LORRI
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:LORRI
Other - Middle Name:LEE
Other - Last Name:FEHLKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1544 S SONORA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9087
Mailing Address - Country:US
Mailing Address - Phone:314-504-8068
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:573-814-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist