Provider Demographics
NPI:1972791788
Name:DERY, LORI E
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:DERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 AYER RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1132
Mailing Address - Country:US
Mailing Address - Phone:978-772-8100
Mailing Address - Fax:978-772-8102
Practice Address - Street 1:325 AYER RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1132
Practice Address - Country:US
Practice Address - Phone:978-772-8100
Practice Address - Fax:978-772-8102
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist