Healthcare Provider Details

I. General information

NPI: 1699753327
Provider Name (Legal Business Name): LORELEI L RAYMUNDO M.S.P.T., PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

73 BARRETT ST APT 2095
NORTHAMPTON MA
01060-1734
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2000
  • Fax:
Mailing address:
  • Phone: 480-639-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3677
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: