Provider Demographics
NPI:1679050389
Name:LORI'S WELLNESS LOFT
Entity type:Organization
Organization Name:LORI'S WELLNESS LOFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FLICKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:609-561-5674
Mailing Address - Street 1:240 S WHITE HOUSE PIKE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-561-5674
Mailing Address - Fax:
Practice Address - Street 1:240 S WHITE HOUSE PIKE
Practice Address - Street 2:SUITE B4
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037
Practice Address - Country:US
Practice Address - Phone:609-561-5674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00965700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty