Provider Demographics
NPI:1922430032
Name:MARTIN, LORI B (RMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5096 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7601
Mailing Address - Country:US
Mailing Address - Phone:719-338-1011
Mailing Address - Fax:
Practice Address - Street 1:1802 CHAPEL HILLS DR
Practice Address - Street 2:SUITE E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3765
Practice Address - Country:US
Practice Address - Phone:719-531-7188
Practice Address - Fax:719-531-0880
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0002312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist