Healthcare Provider Details

I. General information

NPI: 1841615838
Provider Name (Legal Business Name): FRALIN BIOMEDICAL RESEARCH INSTITUTE @ VTC NEUROMOTOR RESEARCH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RIVERSIDE CIR
ROANOKE VA
24016-4950
US

IV. Provider business mailing address

2 RIVERSIDE CIR
ROANOKE VA
24016-4950
US

V. Phone/Fax

Practice location:
  • Phone: 540-526-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE DELUCA
Title or Position: DIRECTOR
Credential: PH.D
Phone: 540-526-2202