Provider Demographics
NPI:1063780419
Name:ABRAMSON, LORI ANN (LMT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:ABRAMSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 MULLAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1856
Mailing Address - Country:US
Mailing Address - Phone:406-543-1955
Mailing Address - Fax:406-543-1506
Practice Address - Street 1:2419 MULLAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1856
Practice Address - Country:US
Practice Address - Phone:406-543-1955
Practice Address - Fax:406-543-1506
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT135OtherMONTANA STATE LICENSE