Provider Demographics
NPI:1912032863
Name:GASKELL, LORI L (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:GASKELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8715 SILVER RD
Mailing Address - Street 2:
Mailing Address - City:OTTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65348-2205
Mailing Address - Country:US
Mailing Address - Phone:660-366-4623
Mailing Address - Fax:866-495-2445
Practice Address - Street 1:12430 TESSON FERRY RD STE 352
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2702
Practice Address - Country:US
Practice Address - Phone:866-495-5437
Practice Address - Fax:866-495-2445
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1081222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487504706Medicaid