Provider Demographics
NPI:1497254650
Name:BURKEY, LORI DENISE (LMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DENISE
Last Name:BURKEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-0579
Mailing Address - Country:US
Mailing Address - Phone:503-932-1065
Mailing Address - Fax:
Practice Address - Street 1:9650 S PACIFIC HWY W
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-9683
Practice Address - Country:US
Practice Address - Phone:503-932-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21949225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist