Provider Demographics
NPI:1265637268
Name:WARREN, LORI LEAN
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LEAN
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:VALERA
Mailing Address - State:TX
Mailing Address - Zip Code:76884-0206
Mailing Address - Country:US
Mailing Address - Phone:325-636-4427
Mailing Address - Fax:325-636-4437
Practice Address - Street 1:2713 S COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-7503
Practice Address - Country:US
Practice Address - Phone:325-625-1591
Practice Address - Fax:325-625-1591
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist