Provider Demographics
NPI:1346349057
Name:CRISWELL, LORI P (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:P
Last Name:CRISWELL
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 1:1100 EASTHAM WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5761
Mailing Address - Country:US
Mailing Address - Phone:239-451-2521
Mailing Address - Fax:239-353-0939
Practice Address - Street 1:1056 GOODLETTE RD N STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5488
Practice Address - Country:US
Practice Address - Phone:239-430-0123
Practice Address - Fax:239-430-0124
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18911225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8438ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER