Healthcare Provider Details

I. General information

NPI: 1396716288
Provider Name (Legal Business Name): LORI MARIE STOKLOSA LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 COLLEGE PARK BLVD
VIRGINIA BEACH VA
23464-4468
US

IV. Provider business mailing address

3556 BOW ST
VIRGINIA BEACH VA
23464-1607
US

V. Phone/Fax

Practice location:
  • Phone: 757-282-2384
  • Fax:
Mailing address:
  • Phone: 757-420-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306601810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: