Provider Demographics
NPI:1568535193
Name:CROWLEY, LORI MELISSA LIEBERMAN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MELISSA LIEBERMAN
Last Name:CROWLEY
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 1:639 W HIND DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1803
Mailing Address - Country:US
Mailing Address - Phone:808-372-5298
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR
Practice Address - Street 2:SUITE 104 AND 108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1855
Practice Address - Country:US
Practice Address - Phone:808-373-4787
Practice Address - Fax:808-373-4787
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI23812-1OtherHMSA QUEST
HIB005OtherTRICARE FOR LIFE PROVIDER
HI52118901Medicaid
HI7797487OtherUNIVERSITY HEALTH ALLIANC
HI209887OtherSUMMERLIN LIFE
HI23812-1OtherHMSA PROVIDER NUMBER
HIB005OtherTRICARE PROVIDER NUMBER
HI54914Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER