Provider Demographics
NPI:1275754954
Name:PELTAK, LORI ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:PELTAK
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 1:1212 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3322
Mailing Address - Country:US
Mailing Address - Phone:305-849-1704
Mailing Address - Fax:
Practice Address - Street 1:5450 MACDONALD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-5903
Practice Address - Country:US
Practice Address - Phone:305-294-8866
Practice Address - Fax:305-294-8898
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist