Provider Demographics
NPI:1922716331
Name:WALTON, LORI MARIE (DPT, PHD, MSCPT)
Entity Type:Individual
Prefix:PROF
First Name:LORI
Middle Name:MARIE
Last Name:WALTON
Suffix:
Gender:F
Credentials:DPT, PHD, MSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MARIMAR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1814
Mailing Address - Country:US
Mailing Address - Phone:785-925-5659
Mailing Address - Fax:
Practice Address - Street 1:52 MARIMAR
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1814
Practice Address - Country:US
Practice Address - Phone:785-925-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0291902251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology