Provider Demographics
NPI:1154576957
Name:MCCONNELL, LORI (DPT)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:MCCONNELL
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 1:7105 180TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-5336
Mailing Address - Country:US
Mailing Address - Phone:425-422-2806
Mailing Address - Fax:
Practice Address - Street 1:7105 180TH ST SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-5336
Practice Address - Country:US
Practice Address - Phone:425-422-2806
Practice Address - Fax:360-668-7199
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60056217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154576957Medicaid
WAG8915420Medicare PIN