Provider Demographics
NPI:1255671632
Name:SWANSON NEBEL, LORI (CMT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:SWANSON NEBEL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3121 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-3017
Mailing Address - Country:US
Mailing Address - Phone:651-484-7899
Mailing Address - Fax:
Practice Address - Street 1:3121 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-3017
Practice Address - Country:US
Practice Address - Phone:651-484-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist