Provider Demographics
NPI:1942605639
Name:KEHOE, LORI ANN (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:KEHOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:PUCHALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6700 FRANCE AVE S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1902
Mailing Address - Country:US
Mailing Address - Phone:952-345-3000
Mailing Address - Fax:952-345-6789
Practice Address - Street 1:6700 FRANCE AVE S
Practice Address - Street 2:SUITE 300
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1902
Practice Address - Country:US
Practice Address - Phone:952-345-3000
Practice Address - Fax:952-345-6789
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist