Provider Demographics
NPI:1649313958
Name:CHRISTIANSON, LORI ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VAIL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3038
Mailing Address - Country:US
Mailing Address - Phone:631-261-0461
Mailing Address - Fax:
Practice Address - Street 1:24 VAIL ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3038
Practice Address - Country:US
Practice Address - Phone:631-261-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011366-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics