Individual
MS. LORI CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2129 W NEW HAVEN AVE, W MELBOURNE, FL 32904
(321) 724-0060
(321) 724-6775
Mailing address
120 BASKIND ROAD, INDIATLANTIC, FL 32903
(321) 604-7224
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA20219
FL
Other
Enumeration date
08/18/2006
Last updated
07/08/2007
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