Provider Demographics
NPI:1609032234
Name:FELDER, LAURA D (MSPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:FELDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:DOMINICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:751 J CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601
Mailing Address - Country:US
Mailing Address - Phone:757-596-1900
Mailing Address - Fax:866-420-0168
Practice Address - Street 1:751 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601
Practice Address - Country:US
Practice Address - Phone:757-596-1900
Practice Address - Fax:866-420-0168
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
239376OtherANTHEM BC
VA8954717Medicaid
VA8954717Medicaid