Provider Demographics
NPI:1285764159
Name:CASE, LYDIA LOREE (ATC)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:LOREE
Last Name:CASE
Suffix:
Gender:F
Credentials:ATC
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Mailing Address - Street 1:4691 VOICE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9604
Mailing Address - Country:US
Mailing Address - Phone:231-313-1112
Mailing Address - Fax:
Practice Address - Street 1:5246 N ROYAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6984
Practice Address - Country:US
Practice Address - Phone:231-929-0303
Practice Address - Fax:231-929-0305
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer