Provider Demographics
NPI:1174843288
Name:BUMPUS, LORI LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEE
Last Name:BUMPUS
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 1:27 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117-3452
Mailing Address - Country:US
Mailing Address - Phone:518-661-8200
Mailing Address - Fax:
Practice Address - Street 1:27 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:NY
Practice Address - Zip Code:12117-3452
Practice Address - Country:US
Practice Address - Phone:518-661-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012556-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics