Provider Demographics
NPI:1851615173
Name:DEERE, LORI MOWBRAY (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MOWBRAY
Last Name:DEERE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DIANE
Other - Last Name:MOWBRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:709 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3914
Mailing Address - Country:US
Mailing Address - Phone:580-220-6285
Mailing Address - Fax:580-220-6287
Practice Address - Street 1:709 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3914
Practice Address - Country:US
Practice Address - Phone:580-220-6285
Practice Address - Fax:580-220-6287
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist