Healthcare Provider Details

I. General information

NPI: 1598450165
Provider Name (Legal Business Name): LAURA BOETEFUER PT, DPT, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 TWINRIDGE LN STE A
NORTH CHESTERFIELD VA
23235-5200
US

IV. Provider business mailing address

163 JENNESS LN APT D
NEWPORT NEWS VA
23602-4229
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-1000
  • Fax:
Mailing address:
  • Phone: 267-986-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213374
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: