Provider Demographics
NPI:1013117589
Name:VYRNE, LORI (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:VYRNE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WEISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:433 PLAZA REAL
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3932
Mailing Address - Country:US
Mailing Address - Phone:561-237-1717
Mailing Address - Fax:561-237-1725
Practice Address - Street 1:433 PLAZA REAL
Practice Address - Street 2:SUITE 255
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3932
Practice Address - Country:US
Practice Address - Phone:561-237-1717
Practice Address - Fax:561-237-1725
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA17624225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA17624OtherSTATE LICENSE