Provider Demographics
NPI:1558908525
Name:HUCKABY, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BELLES COVE DR APT F
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1581
Mailing Address - Country:US
Mailing Address - Phone:571-492-2292
Mailing Address - Fax:
Practice Address - Street 1:10931 E INDEPENDENCE BLVD STE A-11
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5057
Practice Address - Country:US
Practice Address - Phone:980-938-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management