Provider Demographics
NPI:1235640517
Name:KREMER, LORI ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:KREMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 154TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-8276
Mailing Address - Country:US
Mailing Address - Phone:317-496-5754
Mailing Address - Fax:
Practice Address - Street 1:4114 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4315
Practice Address - Country:US
Practice Address - Phone:317-496-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60801680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist