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General NPI Number Information
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NPI Number | 1912252305
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Entity Type | Individual
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Provider Name | LORI ANNE FORWE MSPT
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Gender | Female
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Dates
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Enumeration Date | 07/21/2012
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Last Update Date | 07/21/2012
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Provider Practice Location Address
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Address Line | 14334 HIGHWAY 67
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City | MALVERN
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State | AR
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Zip | 72104-7328
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Country | US
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Telephone | 501-332-6613
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 OXFORD AVE
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City | BENTON
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State | AR
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Zip | 72019-2773
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Country | US
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Telephone | 501-840-1868
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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 | PT2061
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License Number State | AR
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