Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 18432 | MA |
Y | 225100000X | Physical Therapist | 2305206813 | VA |
N | 225100000X | Physical Therapist | 40QA01215900 | NJ |
N | 225100000X | Physical Therapist | PT36159 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | 2305206813 | VA |
NPI | 1124270616 |
---|---|
Provider Name | Lauren Beth Starace |
First Address | Ashburn, VA 20147-4295 |
Second Address | Ashburn, VA 20147-4295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2008 |
Last Update Date | 05/07/2016 |