Provider Demographics
NPI:1396807715
Name:WEBSTER, LORI JOANNE (MPT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JOANNE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE ROAD
Mailing Address - Street 2:ROOM A114
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7038
Mailing Address - Country:US
Mailing Address - Phone:517-355-7648
Mailing Address - Fax:517-432-1319
Practice Address - Street 1:804 SERVICE ROAD
Practice Address - Street 2:ROOM A114
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7038
Practice Address - Country:US
Practice Address - Phone:517-355-7648
Practice Address - Fax:517-432-1319
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396807715Medicaid