Healthcare Provider Details

I. General information

NPI: 1548535859
Provider Name (Legal Business Name): GAIL B DELAPORTE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK ST
FARMVILLE VA
23901-1199
US

IV. Provider business mailing address

800 OAK ST
FARMVILLE VA
23901-1199
US

V. Phone/Fax

Practice location:
  • Phone: 434-315-2920
  • Fax:
Mailing address:
  • Phone: 434-315-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: