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General NPI Number Information
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NPI Number | 1033815162
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Entity Type | Individual
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Provider Name | LORI EBERT LMT
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 229 N MAIN ST SUITE 102
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City | SMYRNA
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State | DE
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Zip | 19977
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Country | US
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Telephone | 302-270-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 229 N MAIN STREET SUITE 102
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City | SMYRNA
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State | DE
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Zip | 19977
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Country | US
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Telephone | 302-270-1090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 101541
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0015203
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License Number State | DE
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