Provider Demographics
NPI:1659851541
Name:HIRZEL, LORI LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LEE
Last Name:HIRZEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:LEE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:431 S EBRITE ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4918
Mailing Address - Country:US
Mailing Address - Phone:469-222-7784
Mailing Address - Fax:
Practice Address - Street 1:8615 LULLWATER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4754
Practice Address - Country:US
Practice Address - Phone:214-342-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105592225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant