Provider Demographics
NPI:1992829402
Name:AUTIELLO LANDRY, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:AUTIELLO LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-4500
Mailing Address - Fax:
Practice Address - Street 1:110 HAVERHILL RD
Practice Address - Street 2:SUITE 401
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2123
Practice Address - Country:US
Practice Address - Phone:978-388-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist