Provider Demographics
NPI:1891983342
Name:RICHARDSON, LORI M (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103400 OVERSEAS HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2834
Mailing Address - Country:US
Mailing Address - Phone:954-785-4776
Mailing Address - Fax:954-785-9789
Practice Address - Street 1:103400 OVERSEAS HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2834
Practice Address - Country:US
Practice Address - Phone:954-785-4776
Practice Address - Fax:954-785-9789
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6607106OtherGHI
FLY916BOtherBLUE SHIELD
7559289OtherAETNA
FLY916BOtherBLUE SHIELD