Provider Demographics
NPI:1265468573
Name:ZELTWANGER, LORI (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ZELTWANGER
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 1:160 ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3709
Mailing Address - Country:US
Mailing Address - Phone:928-821-3749
Mailing Address - Fax:928-282-5140
Practice Address - Street 1:160 ROADRUNNER DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3709
Practice Address - Country:US
Practice Address - Phone:928-821-3749
Practice Address - Fax:928-282-5140
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ975500Medicaid
AZZ106714Medicare PIN