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Individual
MS. LORI SIMMONS MADIARA
Active
Individual
MS. LORI SIMMONS MADIARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
DAPT 000632
PA
225100000X
Physical Therapist
Primary
PT001016E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000634 (M2Y)
MEDICARE CERTIFICATION
PA
01
—
01128601
CAPITAL BC
PA
01
—
MA707038
HIGHMARK BS
PA
Enumeration date
01/24/2008
Last updated
01/24/2008
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