Provider Demographics
NPI:1285059584
Name:PEARSALL, LORIE K (LMT)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:K
Last Name:PEARSALL
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 1:3723 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13408-1836
Mailing Address - Country:US
Mailing Address - Phone:315-391-1228
Mailing Address - Fax:
Practice Address - Street 1:3723 CLARK RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NY
Practice Address - Zip Code:13408-1836
Practice Address - Country:US
Practice Address - Phone:315-391-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-23
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist