Provider Demographics
NPI:1730198490
Name:BANFIELD, LORI (PT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BANFIELD
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 1:1 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-1723
Mailing Address - Country:US
Mailing Address - Phone:518-312-3135
Mailing Address - Fax:
Practice Address - Street 1:314 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1708
Practice Address - Country:US
Practice Address - Phone:518-453-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026059Medicaid
10083262OtherCDPHP
371499OtherMVP
83643OtherGHIHMO
000416437001OtherBSNENY
Q08A21OtherEMPIRE BLUE CROSS
371499OtherMVP
000416437001OtherBSNENY