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General NPI Number Information
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NPI Number | 1710477849
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Entity Type | Individual
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Provider Name | MARY ROBERTSON LAFAR PTA
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Gender | Female
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 117 E KINGS HWY
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City | EDEN
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State | NC
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Zip | 27288-5201
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Country | US
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Telephone | 336-623-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 404 RIDGEWAY DR
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City | GREENSBORO
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State | NC
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Zip | 27403-1531
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Country | US
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Telephone | 336-988-5305
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6503
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License Number State | NC
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