Provider Demographics
NPI:1578642773
Name:SCHOENBERG, LORI JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:SCHOENBERG
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 1:423 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1115
Mailing Address - Country:US
Mailing Address - Phone:570-207-5502
Mailing Address - Fax:570-207-5511
Practice Address - Street 1:423 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-207-5502
Practice Address - Fax:570-207-5511
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102513732Medicaid
PA120620Medicare PIN