Provider Demographics
NPI:1982868451
Name:PAZZABON, LORI ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:PAZZABON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:BAUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:SUITE 107 PROFESSIONAL PLAZA
Mailing Address - City:N CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-1673
Mailing Address - Fax:724-429-0290
Practice Address - Street 1:812 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1664
Practice Address - Country:US
Practice Address - Phone:724-929-5774
Practice Address - Fax:724-929-9524
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019330225100000X
PT019330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396610OtherMEDICARE
PA001593585Medicaid
PA396751OtherMEDICARE
PA001674997Medicaid
PA396610OtherMEDICARE