Healthcare Provider Details

I. General information

NPI: 1881803666
Provider Name (Legal Business Name): EDWARD JOSEPH LEHRE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 DOGTOWN ROAD
GOOCHLAND VA
23063-0000
US

IV. Provider business mailing address

479 CALM CREEK RD
MANAKIN SABOT VA
23103-3164
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-4418
  • Fax:
Mailing address:
  • Phone: 804-784-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: