Provider Demographics
NPI:1114057221
Name:KLEES, LORI ROSE (DPT, OT,)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ROSE
Last Name:KLEES
Suffix:
Gender:F
Credentials:DPT, OT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RUSTY NAIL DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-5714
Mailing Address - Country:US
Mailing Address - Phone:727-385-8159
Mailing Address - Fax:
Practice Address - Street 1:703 HIGHWAY 29N
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28115
Practice Address - Country:US
Practice Address - Phone:727-385-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21523225100000X
NC16680225100000X
FLOT9549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist