Individual
LORA GAYLE STANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1500 N GREEN AVE, PURCELL, OK 73080-1642
(405) 527-6524
(405) 527-1504
Mailing address
PO BOX 511, PURCELL, OK 73080-0511
(405) 527-6524
(405) 527-1504
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2489
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100699900A
—
OK
01
—
37U158
MEDICARE SKILLED FACILITY
OK
Enumeration date
12/16/2010
Last updated
12/16/2010
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