Provider Demographics
NPI:1316082308
Name:ARSENEAULT, LORI ANN (PT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:ARSENEAULT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11019 W AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-3752
Mailing Address - Country:US
Mailing Address - Phone:623-877-0291
Mailing Address - Fax:
Practice Address - Street 1:12409 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE #C306
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-9502
Practice Address - Country:US
Practice Address - Phone:623-935-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics