Provider Demographics
NPI:1639344377
Name:TOENNIES, LORI (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:TOENNIES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HILLTOP LANE
Mailing Address - Street 2:
Mailing Address - City:DAMIANSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62215-1304
Mailing Address - Country:US
Mailing Address - Phone:618-250-0854
Mailing Address - Fax:
Practice Address - Street 1:114 WAKANDA DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1393
Practice Address - Country:US
Practice Address - Phone:618-310-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist