Provider Demographics
NPI:1588601744
Name:GAUMOND, LORI A (PTA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:GAUMOND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 ROURK ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4128
Mailing Address - Country:US
Mailing Address - Phone:843-449-3685
Mailing Address - Fax:843-449-2746
Practice Address - Street 1:8161 ROURK ST
Practice Address - Street 2:STRAND THERAPY INC
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4128
Practice Address - Country:US
Practice Address - Phone:843-449-3685
Practice Address - Fax:843-449-2746
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1131208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation