Healthcare Provider Details

I. General information

NPI: 1942648563
Provider Name (Legal Business Name): NOELLE DRAKEFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax: 703-866-0158
Mailing address:
  • Phone: 757-361-3954
  • Fax: 703-866-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305207996
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: