MEDICARE: MRS. LORI MELISSA LIEBERMAN CROWLEY 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	225100000X	Physical Therapist	2180	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23812-1	OTHER	HI	HMSA QUEST
2	B005	OTHER	HI	TRICARE FOR LIFE PROVIDER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7797487	OTHER	HI	UNIVERSITY HEALTH ALLIANC
5	209887	OTHER	HI	SUMMERLIN LIFE
6	23812-1	OTHER	HI	HMSA PROVIDER NUMBER
7	B005	OTHER	HI	TRICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1568535193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI MELISSA LIEBERMAN CROWLEY DPT

Provider Business Mailing Address
First Line	:	639 W HIND DR
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-1803
Country	:	US
Telephone Number	:	808-372-5298
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W HIND DR
Second Line	:	SUITE 104 AND 108
City	:	HONOLULU
State	:	HI
Zip	:	96821-1855
Country	:	US
Telephone Number	:	808-373-4787
Fax Number	:	808-373-4787

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/09/2007

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Directions to “ MRS. LORI MELISSA LIEBERMAN CROWLEY DPT” Practice Location

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