Provider Demographics
NPI:1730208570
Name:WHEAT, LORI L (DOCTORATE OF PHYSICA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:WHEAT
Suffix:
Gender:F
Credentials:DOCTORATE OF PHYSICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:733 KEYSER AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-0039
Mailing Address - Country:US
Mailing Address - Phone:318-238-4480
Mailing Address - Fax:318-238-4492
Practice Address - Street 1:733 KEYSER AVE
Practice Address - Street 2:STE 100
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-0039
Practice Address - Country:US
Practice Address - Phone:318-238-4480
Practice Address - Fax:318-238-4492
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA01926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1730208570Medicaid