Provider Demographics
NPI:1508264409
Name:TABOR, LORI CHRISTINE (DPT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:CHRISTINE
Last Name:TABOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 NW QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1653
Mailing Address - Country:US
Mailing Address - Phone:541-221-3228
Mailing Address - Fax:
Practice Address - Street 1:408 NE HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4729
Practice Address - Country:US
Practice Address - Phone:541-221-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist