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General NPI Number Information
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NPI Number | 1265723233
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Entity Type | Individual
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Provider Name | GINNIE ILETO
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Gender | Female
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 516 INNOVATION DR STE 100
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3868
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Country | US
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Telephone | 757-842-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 516 INNOVATION DRIVE, SUITE 100
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206851
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 37437
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License Number State | CA
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