Provider Demographics
NPI:1174678569
Name:TEITLER-RIVERA, LORI (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:TEITLER-RIVERA
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 1:72 S FRIEDNER LN
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4218
Mailing Address - Country:US
Mailing Address - Phone:631-218-1545
Mailing Address - Fax:631-218-2650
Practice Address - Street 1:1227 MONTAUK HWY # 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1434
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:631-218-2650
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011325-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist