Provider Demographics
NPI:1497168058
Name:GOTTLIEB, LORI MAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MAE
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MAE
Other - Last Name:KENUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:192 ALLAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8680
Mailing Address - Country:US
Mailing Address - Phone:856-220-1460
Mailing Address - Fax:
Practice Address - Street 1:192 ALLAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:VT
Practice Address - Zip Code:05661-8680
Practice Address - Country:US
Practice Address - Phone:856-220-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0120609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist