Provider Demographics
NPI:1609833003
Name:HANNON, LORI CHRISTINE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:CHRISTINE
Last Name:HANNON
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:CHRISTINE
Other - Last Name:KENDRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS PT
Mailing Address - Street 1:PO BOX 21729
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903
Mailing Address - Country:US
Mailing Address - Phone:501-760-7440
Mailing Address - Fax:501-760-7442
Practice Address - Street 1:1510 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-760-7440
Practice Address - Fax:501-760-7442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13597S721Medicaid
AR5U241OtherBCBS
AR13597S721Medicaid