Provider Demographics
NPI:1174080584
Name:FLICKINGER, LORI ANN (LICENSED MASSAGE)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:FLICKINGER
Suffix:
Gender:F
Credentials:LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S WHITE HORSE PIKE STE B4
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1156
Mailing Address - Country:US
Mailing Address - Phone:609-561-5674
Mailing Address - Fax:
Practice Address - Street 1:240 S WHITE HORSE PIKE STE B4
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1156
Practice Address - Country:US
Practice Address - Phone:609-561-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00965700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist