Provider Demographics
NPI:1245882240
Name:DISERIO, LORI-ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:LORI-ANNE
Middle Name:
Last Name:DISERIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3638
Mailing Address - Country:US
Mailing Address - Phone:732-548-1969
Mailing Address - Fax:732-548-5335
Practice Address - Street 1:3 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3638
Practice Address - Country:US
Practice Address - Phone:732-548-1969
Practice Address - Fax:732-548-5335
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ40QA00532700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist