Provider Demographics
NPI:1417929530
Name:SKOPHAMMER, LORI MARGARET (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARGARET
Last Name:SKOPHAMMER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:848 N RAINBOW BLVD
Mailing Address - Street 2:#357
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:702-256-9738
Mailing Address - Fax:702-242-5629
Practice Address - Street 1:600 S RANCHO DR
Practice Address - Street 2:STE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-258-9381
Practice Address - Fax:702-258-9584
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV1406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417929530Medicaid
NV1417929530Medicaid