MEDICARE: LORI BETH URETSKY ATC,LMT

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	225700000X	Massage Therapist	MT012517	GA
2	2255A2300X	Athletic Trainer	AT003292	GA

General Provider Information

NPI Number	:	1770762338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI BETH URETSKY ATC,LMT

Provider Business Mailing Address
First Line	:	7196A SAVANNAH ST BLDG 663
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31699-1610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7196A SAVANNAH ST BLDG 663
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31699-0001
Country	:	US
Telephone Number	:	609-610-7744
Fax Number	:

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	07/31/2023

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