Healthcare Provider Details

I. General information

NPI: 1588112395
Provider Name (Legal Business Name): LAURA ELIZABETH DORSETT RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 ELM ST STE 300
MC LEAN VA
22101-3845
US

IV. Provider business mailing address

9457 LOVAT RD
FULTON MD
20759-9638
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax:
Mailing address:
  • Phone: 202-812-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: