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General NPI Number Information
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NPI Number | 1871718072
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Entity Type | Individual
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Provider Name | NOEL LASERNA
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Gender | Male
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5000 FAIRBANKS AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1246
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Country | US
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Telephone | 703-797-3869
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Fax | 703-820-2467
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Provider Business Mailing Address
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Address Line | 9788 LORRAINE CAROL WAY
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City | LORTON
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State | VA
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Zip | 22079-2134
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Country | US
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Telephone | 703-339-0150
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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 | 026914
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License Number State | NY
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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 | 2305204532
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License Number State | VA
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