Provider Demographics
NPI:1164808341
Name:BINDER, LORI JOHANNA
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:JOHANNA
Last Name:BINDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14617 N 38TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4514
Mailing Address - Country:US
Mailing Address - Phone:602-800-9787
Mailing Address - Fax:
Practice Address - Street 1:4619 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5203
Practice Address - Country:US
Practice Address - Phone:602-800-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0954171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist