MEDICARE: MRS. CAREY LYNN LOHMAN MPT

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	225100000X	Physical Therapist	2000153024	MO

General Provider Information

NPI Number	:	1447565049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAREY LYNN LOHMAN MPT

Provider Business Mailing Address
First Line	:	1 VILLAGE SQUARE CTR
Second Line	:	SUITE A
City	:	HAZELWOOD
State	:	MO
Zip	:	63042-1817
Country	:	US
Telephone Number	:	314-731-4555
Fax Number	:	314-551-6105

Provider Business Practice Location Address
First Line	:	1 VILLAGE SQUARE CTR
Second Line	:	SUITE A
City	:	HAZELWOOD
State	:	MO
Zip	:	63042-1817
Country	:	US
Telephone Number	:	314-731-4555
Fax Number	:	314-551-6105

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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