Active NPI
Lori Caddoo, MSPT
- Physical Therapist
- Waltham, MA
National Provider Identifier
1275608259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15447
- Practice address
- 564 Main St
Waltham, MA 02452-5516 - Phone
- (781) 894-8880
- Fax
- (781) 894-1121
- NPI assigned
- Nov 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15447 | MA | Primary |
Addresses
Primary practice location
564 Main St
Waltham, MA 02452-5516
Mailing address
564 Main St
Waltham, MA 02452-5516
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y67851 | Other | MA | BCBS PROVIDER # |
| 469563 | Other | MA | TUFTS PROVIDER # |
Other names 1
- Lori Gleason
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15447 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297900800000",
"number": "1275608259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "564 MAIN ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024525516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "564 MAIN ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024525516",
"telephone_number": "781-894-8880",
"fax_number": "781-894-1121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CADDOO",
"first_name": "LORI",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-22",
"last_updated": "2011-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "15447",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "Y67851",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS PROVIDER #",
"identifier": "469563",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LORI",
"last_name": "GLEASON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.