Provider Demographics
NPI:1255454898
Name:INCLEDON, LORI ANN (PTA, ATC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:INCLEDON
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 E LOCUST PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-2631
Mailing Address - Country:US
Mailing Address - Phone:954-560-3748
Mailing Address - Fax:
Practice Address - Street 1:1534 E LOCUST PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-2631
Practice Address - Country:US
Practice Address - Phone:954-560-3748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6046A225200000X
FL9463225200000X
AZ04012255A2300X
FL46492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer