Laura Fogle, P.T.
Individual provider Active NPI Pediatric Physical Therapist · Fort Valley, VA
NPI 1003178583 · NPPES record last updated Jun 11, 2012
Key facts
- NPI
- 1003178583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Physical Therapist 2251P0200X
- License
- 2305001920 (VA)
- Practice address
- 174 Hickory LN
Fort Valley, VA 22652-3208 - Phone
- (540) 933-6455
- NPI assigned
- Jun 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305001920 | VA | MD | Pediatric Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 2305001920 | VA | Yes |
Addresses
Primary practice location
174 Hickory LN
Fort Valley, VA 22652-3208
Mailing address
174 Hickory LN
Fort Valley, VA 22652-3208
Phone (540) 933-6455
Other providers in Fort Valley, VA
All providers in Fort Valley, VA · Pediatric Physical Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.