Provider Demographics
NPI:1588794028
Name:PERSINGER-LOVERN, LORI LEE (PT, OCS)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:PERSINGER-LOVERN
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 COURTHOUSE RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2421
Mailing Address - Country:US
Mailing Address - Phone:304-425-9857
Mailing Address - Fax:304-487-3152
Practice Address - Street 1:311 COURTHOUSE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-425-9857
Practice Address - Fax:304-487-3152
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1405075OtherUMWA
WV0156090000Medicaid
WV0156090000Medicaid