Doctor Name: | LAURA FOGLE |
NPI Number: | 1003178583 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 2305001920 |
Business Practice Address: | 174 Hickory Ln Fort Valley, VA - 226523208 |
Business Phone Number: | 5409336455 |
Business Fax Number: | |
Mailing Address: | 174 Hickory Ln, FORT VALLEY |
State: | VA |
Postal Code: | 226523208 |
Phone Number: | 5409336455 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2012 |
NPI Last Update Date: | 06/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 2305001920 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |