Provider Demographics
NPI:1639287360
Name:EDWARDS, LORI ANN (THERAPIST)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 WILLOWCREEK
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571
Mailing Address - Country:US
Mailing Address - Phone:713-794-7190
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2051982471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy