Healthcare Provider Details

I. General information

NPI: 1417929530
Provider Name (Legal Business Name): LORI MARGARET SKOPHAMMER PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S RANCHO DR STE 103
LAS VEGAS NV
89106
US

IV. Provider business mailing address

848 N RAINBOW BLVD #357
LAS VEGAS NV
89107-1103
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-9381
  • Fax: 702-258-9584
Mailing address:
  • Phone: 702-256-9738
  • Fax: 702-242-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1406
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: