Provider Demographics
NPI:1932197753
Name:MURDOCH, LORRIE LEA (MS PT)
Entity type:Individual
Prefix:MS
First Name:LORRIE
Middle Name:LEA
Last Name:MURDOCH
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:LORRIE
Other - Middle Name:LEA
Other - Last Name:MURDOCH THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6401
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:US HWY 491 N
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6401
Practice Address - Fax:505-368-6431
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09389814Medicaid
NMG8114Medicaid
AZ618390Medicaid
AZ618390Medicaid
8HZ40XMedicare PIN
NMG8114Medicaid