Provider Demographics
NPI:1245290519
Name:LEARY, LORI ANN (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:LEARY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N DUPONT HWY
Mailing Address - Street 2:APT J202
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7811
Mailing Address - Country:US
Mailing Address - Phone:617-519-3908
Mailing Address - Fax:
Practice Address - Street 1:1200 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-2202
Practice Address - Country:US
Practice Address - Phone:302-857-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer