Healthcare Provider Details

I. General information

NPI: 1114057221
Provider Name (Legal Business Name): LORI ROSE KLEES DPT, OT,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 HIGHWAY 29N
CHINA GROVE NC
28115
US

IV. Provider business mailing address

130 RUSTY NAIL DR
MOORESVILLE NC
28115-5714
US

V. Phone/Fax

Practice location:
  • Phone: 727-385-8159
  • Fax:
Mailing address:
  • Phone: 727-385-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21523
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16680
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: