Provider Demographics
NPI:1336412493
Name:LORA-JOHNSON, ELENA M (DPT)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:M
Last Name:LORA-JOHNSON
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 1:275 S MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6462
Mailing Address - Country:US
Mailing Address - Phone:303-776-3800
Mailing Address - Fax:
Practice Address - Street 1:275 S MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6462
Practice Address - Country:US
Practice Address - Phone:303-776-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist