Provider Demographics
NPI:1104474766
Name:JOSEPH, LORI (DPT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5718
Mailing Address - Country:US
Mailing Address - Phone:207-899-0307
Mailing Address - Fax:207-619-7295
Practice Address - Street 1:466 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5718
Practice Address - Country:US
Practice Address - Phone:207-899-0307
Practice Address - Fax:207-619-7295
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist