Individual
MRS. LORI OUELLETTE HUMPHREYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
841 BLOSSOM HILL ROAD, SUITE 103, SAN JOSE, CA 95123
(408) 365-8400
Mailing address
745 MILLSWOOD CT, SAN JOSE, CA 95120-2224
(408) 997-9503
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18218
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18218
PHYSICAL THERAPY LICENSE
CA
Enumeration date
10/21/2008
Last updated
03/28/2022
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