Provider Demographics
NPI:1194976498
Name:GONZALES, LORI (LMT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GONZALES
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 1:8302 INDIANA AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2835
Mailing Address - Country:US
Mailing Address - Phone:806-722-1934
Mailing Address - Fax:
Practice Address - Street 1:8302 INDIANA AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2835
Practice Address - Country:US
Practice Address - Phone:806-722-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-05
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT014241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist