Provider Demographics
NPI:1871779108
Name:GENDREAU, LORI MICHELLE (PT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:MICHELLE
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:TRAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 LOVETT AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1750
Mailing Address - Country:US
Mailing Address - Phone:617-480-6170
Mailing Address - Fax:
Practice Address - Street 1:250 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5030
Practice Address - Country:US
Practice Address - Phone:800-954-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32915225100000X
TX1178760225100000X
MA16018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist