MEDICARE: LORIEN HATHAWAY

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	1162956	TX

General Provider Information

NPI Number	:	1588785695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIEN HATHAWAY

Provider Business Mailing Address
First Line	:	5503 INVERRARY CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-7416
Country	:	US
Telephone Number	:	214-607-4000
Fax Number	:	214-607-4044

Provider Business Practice Location Address
First Line	:	5503 INVERRARY CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-7416
Country	:	US
Telephone Number	:	214-607-4000
Fax Number	:	214-607-4044

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/26/2007

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Directions to “ LORIEN HATHAWAY ” Practice Location

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