Provider Demographics
NPI:1730284704
Name:WEINZATL, LORI A (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:WEINZATL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2251 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8360
Mailing Address - Country:US
Mailing Address - Phone:715-361-2300
Mailing Address - Fax:715-361-2877
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8360
Practice Address - Country:US
Practice Address - Phone:715-361-2300
Practice Address - Fax:715-361-2877
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI646019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40342800Medicaid