Healthcare Provider Details

I. General information

NPI: 1649787797
Provider Name (Legal Business Name): LORIE A GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDDY ST
PROVIDENCE RI
02905-4739
US

IV. Provider business mailing address

1000 EDDY ST
PROVIDENCE RI
02905-4739
US

V. Phone/Fax

Practice location:
  • Phone: 401-533-9100
  • Fax: 401-533-9105
Mailing address:
  • Phone: 401-533-9100
  • Fax: 401-533-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA01163
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberPTA01163
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: