Healthcare Provider Details

I. General information

NPI: 1376980920
Provider Name (Legal Business Name): LAWRENCE NEIL ORD B.A., LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 KEMPSVILLE RD
NORFOLK VA
23502-2205
US

IV. Provider business mailing address

3304 EAMON CT 103
VIRGINIA BEACH VA
23452-6930
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-5001
  • Fax:
Mailing address:
  • Phone: 757-340-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603527
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: