Provider Demographics
NPI:1245556943
Name:SWANTON, LORI GRUBBS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:GRUBBS
Last Name:SWANTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:GRUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1130 SHERIDAN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3656
Mailing Address - Country:US
Mailing Address - Phone:307-213-9595
Mailing Address - Fax:307-939-2249
Practice Address - Street 1:1130 SHERIDAN AVE STE 210
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-213-9595
Practice Address - Fax:307-939-2249
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2159225100000X
AK396225100000X
WY1487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist