Provider Demographics
NPI:1366651184
Name:KRONEBERGER, LORIE MARY (PT)
Entity Type:Individual
Prefix:MS
First Name:LORIE
Middle Name:MARY
Last Name:KRONEBERGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1355 E CLIFFROSE LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7850
Mailing Address - Country:US
Mailing Address - Phone:928-773-0204
Mailing Address - Fax:928-773-7788
Practice Address - Street 1:1355 E CLIFFROSE LN
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7850
Practice Address - Country:US
Practice Address - Phone:928-773-0204
Practice Address - Fax:928-773-7788
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist