| NPI | 1134315963 |
|---|---|
| Former Name | LORI PEACOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT013686L) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2024-11-13 |