Provider Demographics
NPI:1770317000
Name:MORAN, LORI ELIZABETH (MMT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELIZABETH
Last Name:MORAN
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-0444
Mailing Address - Country:US
Mailing Address - Phone:501-394-5867
Mailing Address - Fax:
Practice Address - Street 1:117 E FRONT ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3237
Practice Address - Country:US
Practice Address - Phone:501-394-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist