Healthcare Provider Details

I. General information

NPI: 1023518222
Provider Name (Legal Business Name): LUCY LEYDEN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY CATH

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 LASKIN RD
VIRGINIA BEACH VA
23451-6007
US

IV. Provider business mailing address

9605 6TH VIEW ST
NORFOLK VA
23503-1404
US

V. Phone/Fax

Practice location:
  • Phone: 757-263-2800
  • Fax: 757-263-2801
Mailing address:
  • Phone: 757-636-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006650
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: