Provider Demographics
NPI:1346424041
Name:SKYLES, LORI LYNN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:SKYLES
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 1:1100 NE 178TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6322
Mailing Address - Country:US
Mailing Address - Phone:503-669-7472
Mailing Address - Fax:503-669-7472
Practice Address - Street 1:1100 NE 178TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6322
Practice Address - Country:US
Practice Address - Phone:503-669-7472
Practice Address - Fax:503-669-7472
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7127225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant