Individual
LORI RENEE CHARLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2048
(360) 575-6749
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2048
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00006513
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0161310
LABOR & IND.
WA
01
—
0218607
LABOR & IND PHMG
WA
05
—
182763
—
OR
05
—
8323891
—
WA
01
—
8943912
CRIME VICTIMS
WA
Enumeration date
03/06/2007
Last updated
07/09/2007
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