Individual
LORI LYNN ROELOFS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
20902 BAKE PKWY, SUITE 100, LAKE FOREST, CA 92630-2175
(949) 600-5437
(949) 600-5439
Mailing address
4 CLEMENTINE ST, TRABUCO CANYON, CA 92679-5303
(949) 422-7839
(949) 713-0110
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
25455
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT254550
BLUE CROSS PROVIDER ID
CA
Enumeration date
06/23/2010
Last updated
10/16/2011
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