Provider Demographics
NPI:1689755514
Name:SWEENEY, LORI A (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:RAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, ATC
Mailing Address - Street 1:167 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3524
Mailing Address - Country:US
Mailing Address - Phone:610-637-8583
Mailing Address - Fax:610-660-2577
Practice Address - Street 1:5600 CITY AVE
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1308
Practice Address - Country:US
Practice Address - Phone:610-660-1699
Practice Address - Fax:610-660-2577
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001380A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer