Provider Demographics
NPI:1821126152
Name:LUBOW, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LUBOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 TERRITORY PASS
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6118
Mailing Address - Country:US
Mailing Address - Phone:952-447-3886
Mailing Address - Fax:
Practice Address - Street 1:14180 COMMERCE AVE NE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1483
Practice Address - Country:US
Practice Address - Phone:952-447-3395
Practice Address - Fax:952-447-3396
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist