Provider Demographics
NPI:1942312327
Name:AMELUNKE, LORA LEIGH (PT)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LEIGH
Last Name:AMELUNKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:AMELUNKE
Other - Last Name:BURDETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6606 E CARONDELET DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2119
Mailing Address - Country:US
Mailing Address - Phone:520-296-8513
Mailing Address - Fax:
Practice Address - Street 1:6606 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-296-8513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77336Medicare PIN