Provider Demographics
NPI:1487051991
Name:VANDERHOOF, LORI (CPO, LPO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BLACK DIAMOND DR APT 1406
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-0270
Mailing Address - Country:US
Mailing Address - Phone:936-777-2111
Mailing Address - Fax:
Practice Address - Street 1:2939 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4411
Practice Address - Country:US
Practice Address - Phone:850-248-0016
Practice Address - Fax:850-248-0017
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR330222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist