Provider Demographics
NPI:1427330414
Name:GASTER MURRAY, LORI M (PTA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:M
Last Name:GASTER MURRAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:M
Other - Last Name:GASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:13413 E 89TH PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2541
Mailing Address - Country:US
Mailing Address - Phone:918-274-9212
Mailing Address - Fax:
Practice Address - Street 1:4157 S HARVARD AVE STE 117
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2606
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-392-7868
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK837225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant