Provider Demographics
NPI:1801013875
Name:MACNAUGHTON, LORRAINE S (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:S
Last Name:MACNAUGHTON
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 1:30486 PASSAGEWAY PL
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2031
Mailing Address - Country:US
Mailing Address - Phone:818-597-2531
Mailing Address - Fax:818-597-2532
Practice Address - Street 1:10605 BALBOA BLVD STE 330
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6358
Practice Address - Country:US
Practice Address - Phone:818-832-7200
Practice Address - Fax:818-832-7249
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist