Provider Demographics
NPI:1629534011
Name:MANTHEY, LORI ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:MANTHEY
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 1:1961 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6492
Mailing Address - Country:US
Mailing Address - Phone:507-345-5023
Mailing Address - Fax:507-345-5023
Practice Address - Street 1:1961 PREMIER DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6492
Practice Address - Country:US
Practice Address - Phone:507-345-5023
Practice Address - Fax:507-345-5023
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA316208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation