Provider Demographics
NPI:1184046625
Name:ROTHROCK, LORI (PT, MPT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:ROTHROCK
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1740
Mailing Address - Country:US
Mailing Address - Phone:410-980-7200
Mailing Address - Fax:
Practice Address - Street 1:1 WAHOO DRIVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-3809
Practice Address - Country:US
Practice Address - Phone:860-694-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60311223225100000X
MA15705225100000X
MD21817225100000X
CT011340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist