Doctor Name: | MRS. LARISSA GIZELLE NEAL |
NPI Number: | 1053579250 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2305204903 |
Business Practice Address: | 1640 Redstone Center Dr 200 Park City, UT - 840987605 |
Business Phone Number: | 8888008744 |
Business Fax Number: | |
Mailing Address: | 44863 Milestone Sq, 302 ASHBURN |
State: | VA |
Postal Code: | 201474203 |
Phone Number: | 7037297311 |
Fax Number: | |
NPI Enumeration Date: | 05/26/2008 |
NPI Last Update Date: | 05/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251G0304X |
License Number: | 2305204903 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Geriatrics |
Taxonomy Definition: |