Provider Demographics
NPI:1417246430
Name:ROSE, LORI RAE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RAE
Last Name:ROSE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 RIVER ST
Mailing Address - Street 2:STE 201
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3792
Mailing Address - Country:US
Mailing Address - Phone:802-262-1500
Mailing Address - Fax:
Practice Address - Street 1:81 RIVER ST
Practice Address - Street 2:STE 201
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3792
Practice Address - Country:US
Practice Address - Phone:802-262-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist