Provider Demographics
NPI:1538346168
Name:TISSUE, LORI MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MARGARET
Last Name:TISSUE
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 1:471 BRIERLY LN
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8947
Mailing Address - Country:US
Mailing Address - Phone:724-625-3824
Mailing Address - Fax:
Practice Address - Street 1:471 BRIERLY LN
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8947
Practice Address - Country:US
Practice Address - Phone:724-625-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007464L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics