Provider Demographics
NPI:1942243027
Name:BLUEMER-TIERNEY, LORI ANN (MPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BLUEMER-TIERNEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3138
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3138
Mailing Address - Country:US
Mailing Address - Phone:208-659-0750
Mailing Address - Fax:208-772-0246
Practice Address - Street 1:402 W CANFIELD AVE
Practice Address - Street 2:STE 5
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7784
Practice Address - Country:US
Practice Address - Phone:208-659-0750
Practice Address - Fax:208-772-0246
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1655309Medicare UPIN