Provider Demographics
NPI:1114406147
Name:LANCASTER, KORY SHAWN (PT)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:SHAWN
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1042
Mailing Address - Country:US
Mailing Address - Phone:817-483-1746
Mailing Address - Fax:817-483-5874
Practice Address - Street 1:6033 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1042
Practice Address - Country:US
Practice Address - Phone:817-483-1746
Practice Address - Fax:817-483-5874
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1308098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1308098OtherTEXAS BOARD OF PT EXAMINERS