Provider Demographics
NPI:1629443866
Name:SPOONER-PORTER, LORI (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:SPOONER-PORTER
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-2015
Mailing Address - Country:US
Mailing Address - Phone:508-335-8517
Mailing Address - Fax:
Practice Address - Street 1:1 KINGS WAY
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-2015
Practice Address - Country:US
Practice Address - Phone:508-335-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108232251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics