Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01383400 | NJ |
N | 225100000X | Physical Therapist | PT009916 | GA |
NPI | 1003008806 |
---|---|
Provider Name | Dr. Laurie Ann Valenzano |
First Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Second Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2007 |
Last Update Date | 26/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116819 | REHABILITATION AGENCY CERTIFICATION (01) | GA |
426619 | REHABILITATION AGENCY CERTIFICATION (01) | SC |