Provider Demographics
NPI:1962456954
Name:DIAMOS, LORI (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DIAMOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:800 DEVON AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4760
Practice Address - Country:US
Practice Address - Phone:847-292-4710
Practice Address - Fax:847-292-4903
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK31534Medicare PIN
ILK31535Medicare PIN