Healthcare Provider Details

I. General information

NPI: 1750214219
Provider Name (Legal Business Name): AURELIS MARIE FELICIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

7500 JACKSON ARCH DR STE G
MECHANICSVILLE VA
23111-4458
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 804-559-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: