Provider Demographics
NPI:1053744938
Name:KEATHLEY, LORI (LPTA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KEATHLEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 S DEAD HORSE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-9142
Mailing Address - Country:US
Mailing Address - Phone:479-841-1048
Mailing Address - Fax:
Practice Address - Street 1:3196 S DEAD HORSE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-9142
Practice Address - Country:US
Practice Address - Phone:479-841-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLPTA 1380225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant