Provider Demographics
NPI:1487102695
Name:THOMPSON, LORI RENAE (DPT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:RENAE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:RENAE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84021-0164
Mailing Address - Country:US
Mailing Address - Phone:435-840-8116
Mailing Address - Fax:
Practice Address - Street 1:7331 E OSBORN DR STE 410
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6422
Practice Address - Country:US
Practice Address - Phone:480-443-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12125225100000X
UT9636095-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist