Individual
LORI B GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3034 COUNTY ROAD 611, VALLEY HEAD, AL 35989-4623
(912) 996-3567
(855) 232-8604
Mailing address
3034 COUNTY ROAD 611, VALLEY HEAD, AL 35989-4623
(912) 996-3567
(855) 232-8604
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
14-03493
KS
225200000X
Physical Therapy Assistant
7501
TN
225200000X
Physical Therapy Assistant
Primary
PTA004592
GA
225200000X
Physical Therapy Assistant
PTA10177
AL
Other
Enumeration date
03/22/2019
Last updated
05/03/2021
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