Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO04815 | VA |
NPI | 1952866659 |
---|---|
Provider Name | Lorrin Avery Herbert |
First Address | Virginia Beach, VA 23452-1171 |
Second Address | Virginia Beach, VA 23452-1171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |