Provider Demographics
NPI:1588784771
Name:STANESZEWSKI, LORI MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MARIE
Last Name:STANESZEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10726 MIRACLE LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-3664
Mailing Address - Country:US
Mailing Address - Phone:727-856-5714
Mailing Address - Fax:
Practice Address - Street 1:7206 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2934
Practice Address - Country:US
Practice Address - Phone:727-842-2223
Practice Address - Fax:727-842-2236
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 14052225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant