Provider Demographics
NPI:1710171202
Name:LOWRIMORE, LAURA JUNE (PTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JUNE
Last Name:LOWRIMORE
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 1:6440 EDMUND HWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-8205
Mailing Address - Country:US
Mailing Address - Phone:803-755-7130
Mailing Address - Fax:
Practice Address - Street 1:6440 EDMUND HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8205
Practice Address - Country:US
Practice Address - Phone:803-755-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1879225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant