Provider Demographics
NPI:1740310382
Name:BERDO, LORI ANN (PT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:BERDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:BERDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:21 IVY TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4220
Mailing Address - Country:US
Mailing Address - Phone:404-841-5887
Mailing Address - Fax:
Practice Address - Street 1:1441 CLIFTON ROAD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30222-1004
Practice Address - Country:US
Practice Address - Phone:404-712-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist