Provider Demographics
NPI:1619258456
Name:BLEVINS, LORI LEA (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEA
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LEA
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1310 SIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7628
Mailing Address - Country:US
Mailing Address - Phone:870-612-7200
Mailing Address - Fax:870-612-7203
Practice Address - Street 1:1310 SIDNEY ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7628
Practice Address - Country:US
Practice Address - Phone:870-612-7200
Practice Address - Fax:870-612-7203
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant