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General NPI Number Information
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NPI Number | 1356332415
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Entity Type | Individual
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Provider Name | LORA A MIZE DPT
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Gender | Female
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 701 REEDY RD
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City | CONWAY
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State | AR
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Zip | 72034-9383
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Country | US
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Telephone | 870-612-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 RIVERMONT AVE OUTPATIENT THERAPY ADMINISTRATION
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City | LYNCHBURG
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State | VA
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Zip | 24503
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Country | US
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Telephone | 434-200-5032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2770
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License Number State | AR
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