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General NPI Number Information
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NPI Number | 1871779108
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Entity Type | Individual
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Provider Name | LORI MICHELLE GENDREAU PT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 250 INTERNATIONAL PKWY SUITE 260
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City | LAKE MARY
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State | FL
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Zip | 32746-5030
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Country | US
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Telephone | 800-954-9645
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Fax |
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Provider Business Mailing Address
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Address Line | 23 LOVETT AVE
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City | BROCKTON
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State | MA
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Zip | 02301-1750
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Country | US
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Telephone | 617-480-6170
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 32915
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1178760
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16018
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License Number State | MA
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