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General NPI Number Information
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NPI Number | 1487051991
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Entity Type | Individual
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Provider Name | LORI VANDERHOOF CPO, LPO
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Gender | Female
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 2939 MARTIN LUTHER KING JR BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32405-4411
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Country | US
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Telephone | 850-248-0016
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Fax | 850-248-0017
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Provider Business Mailing Address
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Address Line | 1400 BLACK DIAMOND DR APT 1406
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-0270
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Country | US
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Telephone | 936-777-2111
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | POR330
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | POR330
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License Number State | FL
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