Provider Demographics
NPI:1689953200
Name:KROH, LORI ELISE (LMT, CRM, CNC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELISE
Last Name:KROH
Suffix:
Gender:F
Credentials:LMT, CRM, CNC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELISE
Other - Last Name:BURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:2617 S MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2653
Mailing Address - Country:US
Mailing Address - Phone:206-235-3318
Mailing Address - Fax:
Practice Address - Street 1:906 N 101ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9325
Practice Address - Country:US
Practice Address - Phone:206-816-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60118669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist