Provider Demographics
NPI:1487895819
Name:DOE, LORI L (LMT, CNMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:DOE
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 CALICO PATCH HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5809
Mailing Address - Country:US
Mailing Address - Phone:719-360-1611
Mailing Address - Fax:
Practice Address - Street 1:6216 CALICO PATCH HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5809
Practice Address - Country:US
Practice Address - Phone:719-360-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-15
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO708498172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist