Provider Demographics
NPI:1689203804
Name:MEARS, LORI J (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:MEARS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17225 SE 248TH TER
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9146
Mailing Address - Country:US
Mailing Address - Phone:352-434-5389
Mailing Address - Fax:
Practice Address - Street 1:17225 SE 248TH TER
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9146
Practice Address - Country:US
Practice Address - Phone:352-434-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist