Provider Demographics
NPI:1760688741
Name:MOOMAW, LORI JEAN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:MOOMAW
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S CROWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1325
Mailing Address - Country:US
Mailing Address - Phone:330-683-2963
Mailing Address - Fax:
Practice Address - Street 1:275 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1165
Practice Address - Country:US
Practice Address - Phone:330-927-2060
Practice Address - Fax:330-927-4501
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00885225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant