Provider Demographics
NPI:1962687129
Name:NOTZ, LORI (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:NOTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 HEIDER RD
Mailing Address - Street 2:
Mailing Address - City:ABRAMS
Mailing Address - State:WI
Mailing Address - Zip Code:54101-9602
Mailing Address - Country:US
Mailing Address - Phone:920-826-2436
Mailing Address - Fax:
Practice Address - Street 1:7120 HEIDER RD
Practice Address - Street 2:
Practice Address - City:ABRAMS
Practice Address - State:WI
Practice Address - Zip Code:54101-9602
Practice Address - Country:US
Practice Address - Phone:920-826-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1168-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant