Provider Demographics
NPI:1598217531
Name:LASERNA, JEREMAY RODERO
Entity Type:Individual
Prefix:MRS
First Name:JEREMAY
Middle Name:RODERO
Last Name:LASERNA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JEREMAY
Other - Middle Name:OLARTE
Other - Last Name:RODERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:185 HAILEY LN APT H9
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22657-3756
Mailing Address - Country:US
Mailing Address - Phone:804-683-2821
Mailing Address - Fax:
Practice Address - Street 1:185 HAILEY LN APT H9
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-3756
Practice Address - Country:US
Practice Address - Phone:804-683-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist