Provider Demographics
NPI:1326085184
Name:VAZQUEZ, LORI ANN (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 MILSTEAD RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3835
Mailing Address - Country:US
Mailing Address - Phone:404-778-7399
Mailing Address - Fax:770-761-6849
Practice Address - Street 1:1567 MILSTEAD RD NE STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3835
Practice Address - Country:US
Practice Address - Phone:404-778-7399
Practice Address - Fax:770-761-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0893026062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer