Provider Demographics
NPI:1811224108
Name:MCNAIR, LORI ELLEN (PTA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ELLEN
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE A-106
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2878
Mailing Address - Country:US
Mailing Address - Phone:480-730-5656
Mailing Address - Fax:480-730-9969
Practice Address - Street 1:2175 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE A-106
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2878
Practice Address - Country:US
Practice Address - Phone:480-730-5656
Practice Address - Fax:480-730-9969
Is Sole Proprietor?:No
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5802A225200000X
OR7915225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant