Provider Demographics
NPI:1609041466
Name:SHUFORD, LORI (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:SHUFORD
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 1:404 HOLLY BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5837
Mailing Address - Country:US
Mailing Address - Phone:919-552-2610
Mailing Address - Fax:
Practice Address - Street 1:1995 E CORNELIUS HARNETT BLVD
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8276
Practice Address - Country:US
Practice Address - Phone:910-893-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2962225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant