Provider Demographics
NPI:1083730790
Name:HALE, LAURA NICOLE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NICOLE
Last Name:HALE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TURNER LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5606
Mailing Address - Country:US
Mailing Address - Phone:703-421-0176
Mailing Address - Fax:
Practice Address - Street 1:20535 EARHART PL
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-3581
Practice Address - Country:US
Practice Address - Phone:703-404-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant