Provider Demographics
NPI:1912097270
Name:MATHEWSON, LORRI JEAN (RMT, LMT)
Entity Type:Individual
Prefix:
First Name:LORRI
Middle Name:JEAN
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:RMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 KINNE ST
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2261
Mailing Address - Country:US
Mailing Address - Phone:716-465-2784
Mailing Address - Fax:
Practice Address - Street 1:206 KINNE ST
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2261
Practice Address - Country:US
Practice Address - Phone:716-465-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007711225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist