Provider Demographics
NPI:1699815787
Name:DENTINGER, LORI ANN YERIAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN YERIAN
Last Name:DENTINGER
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 1:408 HIGUERA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6135
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:835 C ST STE 130
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2802
Practice Address - Country:US
Practice Address - Phone:209-745-5802
Practice Address - Fax:209-745-5574
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA0164OtherALTA CALIFORNIA REGIONAL
CAPT0015530OtherMEDI-CAL PROVIDER NUMBER