Healthcare Provider Details

I. General information

NPI: 1790461895
Provider Name (Legal Business Name): LAURA FIKE EP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
LANGLEY AFB VA
23665-2040
US

IV. Provider business mailing address

821 NORWYK LN
WILLIAMSBURG VA
23188-1598
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-3948
  • Fax:
Mailing address:
  • Phone: 502-316-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number797956
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: