Provider Demographics
NPI:1770594137
Name:CARLSON, LORI J (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:693 BLOOMFIELD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2489
Mailing Address - Country:US
Mailing Address - Phone:860-242-8427
Mailing Address - Fax:860-242-4147
Practice Address - Street 1:693 BLOOMFIELD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2489
Practice Address - Country:US
Practice Address - Phone:860-242-8427
Practice Address - Fax:860-242-4147
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03284991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist