Provider Demographics
NPI:1336396498
Name:TACKMANN, LORI SUE (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUE
Last Name:TACKMANN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BEVERAGE HILL AVE
Mailing Address - Street 2:#C5
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-4400
Mailing Address - Country:US
Mailing Address - Phone:401-252-9500
Mailing Address - Fax:
Practice Address - Street 1:724 BEVERAGE HILL AVE
Practice Address - Street 2:#C5
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-4400
Practice Address - Country:US
Practice Address - Phone:401-252-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT00913173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist