MEDICARE: LORA J CLOTHIER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	PT00009027	WA
2	225100000X	Physical Therapist	PT00009027	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	G8904843	OTHER	WA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0282806	OTHER	WA	LABOR & INDUSTRIES
2	1193SC	OTHER	WA	REGENCE BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326020926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA J CLOTHIER DPT

Provider Business Mailing Address
First Line	:	3727 CALIFORNIA AVE SW
Second Line	:	SUITE 1-A
City	:	SEATTLE
State	:	WA
Zip	:	98116-3753
Country	:	US
Telephone Number	:	206-938-0860
Fax Number	:	206-938-0866

Provider Business Practice Location Address
First Line	:	3727 CALIFORNIA AVE SW
Second Line	:	SUITE 1-A
City	:	SEATTLE
State	:	WA
Zip	:	98116-4303
Country	:	US
Telephone Number	:	206-938-0860
Fax Number	:	206-938-0866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	10/13/2022

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Directions to “ LORA J CLOTHIER DPT” Practice Location

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