Healthcare Provider Details

I. General information

NPI: 1710683321
Provider Name (Legal Business Name): MRS. CHARIS LOUISE ROBINETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CHARIS LOUISE MORTIMER

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26181 PARKSLEY RD
PARKSLEY VA
23421-3723
US

IV. Provider business mailing address

3395 MAIN AVE
CAPE CHARLES VA
23310-1411
US

V. Phone/Fax

Practice location:
  • Phone: 757-665-5133
  • Fax:
Mailing address:
  • Phone: 757-775-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605696
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: