Provider Demographics
NPI:1891438099
Name:LORI BLONDELL DPT LLC
Entity Type:Organization
Organization Name:LORI BLONDELL DPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLONDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-360-3824
Mailing Address - Street 1:800 N TAMIAMI TRL UNIT 1505
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4022
Mailing Address - Country:US
Mailing Address - Phone:610-360-3824
Mailing Address - Fax:
Practice Address - Street 1:800 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4054
Practice Address - Country:US
Practice Address - Phone:610-360-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy