Provider Demographics
NPI:1811573942
Name:MARTINSON, LORA C (DPT)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:C
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:C
Other - Last Name:REMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:14884 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8451
Mailing Address - Country:US
Mailing Address - Phone:218-824-5027
Mailing Address - Fax:
Practice Address - Street 1:14884 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8451
Practice Address - Country:US
Practice Address - Phone:218-824-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist