Basic Information
| Provider Information | |||||||||
| NPI: | 1174662860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PICKERING | ||||||||
| FirstName: | LORA | ||||||||
| MiddleName: | LEA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 ARBOR KNOLL BLVD | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370135393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152601184 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 STONECREST PKWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152201122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 3599 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.