Provider Demographics
NPI:1699239574
Name:FLOYD, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16885 MARTINSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:AXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24054-1929
Mailing Address - Country:US
Mailing Address - Phone:276-252-3632
Mailing Address - Fax:
Practice Address - Street 1:16885 MARTINSVILLE HWY
Practice Address - Street 2:
Practice Address - City:AXTON
Practice Address - State:VA
Practice Address - Zip Code:24054-1929
Practice Address - Country:US
Practice Address - Phone:276-252-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0167976110Medicaid