Provider Demographics
NPI:1578795001
Name:SOPER, LORI LEANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEANNE
Last Name:SOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7789 N STATE HIGHWAY V
Mailing Address - Street 2:
Mailing Address - City:ASH GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65604-8840
Mailing Address - Country:US
Mailing Address - Phone:417-751-3117
Mailing Address - Fax:
Practice Address - Street 1:500 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-1005
Practice Address - Country:US
Practice Address - Phone:417-751-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001023613225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant