Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305206522 | VA |
NPI | 1003114661 |
---|---|
Provider Name | Janice Anne Barrera |
First Address | Virginia Beach, VA 23464-4128 |
Second Address | Virginia Beach, VA 23464-4128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2011 |
Last Update Date | 13/11/2015 |