Provider Demographics
NPI:1962510941
Name:SWALDI, LORI T (DPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:T
Last Name:SWALDI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PARK AVE
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:MARION HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:17832
Mailing Address - Country:US
Mailing Address - Phone:570-373-3300
Mailing Address - Fax:570-373-3363
Practice Address - Street 1:600 PARK AVE
Practice Address - Street 2:
Practice Address - City:MARION HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:17832
Practice Address - Country:US
Practice Address - Phone:570-373-3300
Practice Address - Fax:570-373-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009706L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019261180002Medicaid
PA50014440OtherBLUE CROSS
PAST1470980OtherBLUE SHIELD
PA069192RPLMedicare ID - Type UnspecifiedMEDICARE