Provider Demographics
NPI:1588845291
Name:FLEETWOOD, LORELIE
Entity Type:Individual
Prefix:
First Name:LORELIE
Middle Name:
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13999 E CARTER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-6125
Mailing Address - Country:US
Mailing Address - Phone:812-350-8315
Mailing Address - Fax:
Practice Address - Street 1:2346 MEADOW BEND DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1426
Practice Address - Country:US
Practice Address - Phone:812-350-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist