Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 009952 | CT |
Y | 225100000X | Physical Therapist | 2305210750 | VA |
NPI | 1003118704 |
---|---|
Provider Name | Mrs. Mona Fazzina |
First Address | Lynchburg, VA 24502-7352 |
Second Address | Lynchburg, VA 24501-1422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2010 |
Last Update Date | 19/12/2016 |