Provider Demographics
NPI:1851578645
Name:MADIARA, LORI SIMMONS (PT DPT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:SIMMONS
Last Name:MADIARA
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1515 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:610-737-7072
Mailing Address - Fax:
Practice Address - Street 1:451 CHOW ST
Practice Address - Street 2:SMOLCZYNSKI PHYSICAL THERAPY ASSOCIATES
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-432-7733
Practice Address - Fax:610-432-7951
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001016E225100000X
PADAPT 000632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01128601OtherCAPITAL BC
PAMA707038OtherHIGHMARK BS
PA000634 (M2Y)OtherMEDICARE CERTIFICATION
PAMA707038OtherHIGHMARK BS