Provider Demographics
NPI:1740210293
Name:TSOSIE, LORI LEE (PT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEE
Last Name:TSOSIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1801 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2103
Mailing Address - Country:US
Mailing Address - Phone:405-295-1475
Mailing Address - Fax:405-295-1679
Practice Address - Street 1:1801 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2103
Practice Address - Country:US
Practice Address - Phone:405-295-1475
Practice Address - Fax:405-295-1679
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM41174208Medicaid
NM41174208Medicaid
NM8HE907Medicare ID - Type Unspecified