Provider Demographics
NPI:1629185723
Name:SMITH, LORA (DPT)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NE 10TH ST
Mailing Address - Street 2:OUPB SUITE 5300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5417
Mailing Address - Country:US
Mailing Address - Phone:405-271-9490
Mailing Address - Fax:
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:OUPB SUITE 5300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-9490
Practice Address - Fax:405-271-9491
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094760AMedicaid
OK1629185723OtherTRICARE
OK1629185723OtherBCBS
OK1629185723OtherBCBS
OK376528Medicare PIN
OK200094760AMedicaid