Basic Information
| Provider Information | |||||||||
| NPI: | 1578795001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOPER | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | LEANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7789 N STATE HIGHWAY V | ||||||||
| Address2: | |||||||||
| City: | ASH GROVE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656048840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177513117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 N MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | ASH GROVE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656041005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177512575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 08/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2001023613 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.