Provider Demographics
NPI:1336485549
Name:LARNER, SUSANNA MARIE (L-ATC)
Entity Type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:MARIE
Last Name:LARNER
Suffix:
Gender:F
Credentials:L-ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 HORNET RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-3413
Mailing Address - Country:US
Mailing Address - Phone:540-886-4286
Mailing Address - Fax:540-886-4611
Practice Address - Street 1:189 HORNET RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-3413
Practice Address - Country:US
Practice Address - Phone:540-886-4286
Practice Address - Fax:540-886-4611
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260002882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer