Provider Demographics
NPI:1528101268
Name:RAHAIM, LORI ANNE (MED, ATC, LAT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:RAHAIM
Suffix:
Gender:F
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROUTE 340
Mailing Address - Street 2:
Mailing Address - City:SPARKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10976-1041
Mailing Address - Country:US
Mailing Address - Phone:845-304-3177
Mailing Address - Fax:845-398-4071
Practice Address - Street 1:125 ROUTE 340
Practice Address - Street 2:
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1041
Practice Address - Country:US
Practice Address - Phone:845-304-3177
Practice Address - Fax:845-398-4071
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001212-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer