Provider Demographics
NPI:1558402180
Name:LORA, ERIN LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:LORA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LYNN
Other - Last Name:WILTSHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:407-833-0802
Mailing Address - Fax:407-833-8931
Practice Address - Street 1:1337 S INTERNATIONAL PKWY STE 1321
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1402
Practice Address - Country:US
Practice Address - Phone:407-833-0802
Practice Address - Fax:407-833-8931
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32424225100000X
FLPT23850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29668ZOtherMEDICARE PTAN
CA0PT324240Medicare ID - Type Unspecified
CAZZZ29668ZOtherMEDICARE PTAN