Provider Demographics
NPI:1033210141
Name:STUBBS, LORI SHANNON (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SHANNON
Last Name:STUBBS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MCCARSON RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:SC
Mailing Address - Zip Code:29661-9205
Mailing Address - Country:US
Mailing Address - Phone:864-836-3663
Mailing Address - Fax:
Practice Address - Street 1:712 N A ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2142
Practice Address - Country:US
Practice Address - Phone:864-859-4938
Practice Address - Fax:864-859-3345
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant