Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305002095 | VA |
NPI | 1083862569 |
---|---|
Provider Name | Mrs. Lucille Ann Daigle |
First Address | Portsmouth, VA 23701-1217 |
Second Address | Norfolk, VA 23507-1505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2008 |
Last Update Date | 09/09/2008 |