Provider Demographics
NPI:1467636597
Name:DEIBLER, LORRAINE M (PT)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:M
Last Name:DEIBLER
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 1:1844 E BASELINE RD STE C5
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1506
Mailing Address - Country:US
Mailing Address - Phone:480-883-1005
Mailing Address - Fax:480-833-1312
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 125
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8978
Practice Address - Country:US
Practice Address - Phone:520-568-2723
Practice Address - Fax:520-568-2865
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-003464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ84808Medicare PIN