Provider Demographics
NPI:1285843078
Name:JANES, LORI HODGES (PTA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:HODGES
Last Name:JANES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 PINE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7542
Mailing Address - Country:US
Mailing Address - Phone:502-386-4535
Mailing Address - Fax:
Practice Address - Street 1:120 LIFE CARE WAY
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2059
Practice Address - Country:US
Practice Address - Phone:502-422-0348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00921225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant