Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305208878 | VA |
NPI | 1003219122 |
---|---|
Provider Name | Laura Elizabeth Fenno |
First Address | Roanoke, VA 24019-6080 |
Second Address | Salem, VA 24153-1961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2014 |
Last Update Date | 02/10/2014 |