Provider Demographics
NPI:1184898678
Name:MAJESTIC, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MAJESTIC
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 1:2329 W MAIN STREET
Mailing Address - Street 2:STE 102
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8210
Mailing Address - Country:US
Mailing Address - Phone:303-797-0988
Mailing Address - Fax:303-797-8011
Practice Address - Street 1:2329 W MAIN STREET
Practice Address - Street 2:STE 102
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8210
Practice Address - Country:US
Practice Address - Phone:303-797-0988
Practice Address - Fax:303-797-8011
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8026225100000X
COPTL.0011392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist