Provider Demographics
NPI:1629739669
Name:GARRISON, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 MERRIDITH CIR APT 407
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4686
Mailing Address - Country:US
Mailing Address - Phone:325-513-5248
Mailing Address - Fax:
Practice Address - Street 1:24801 PINEBROOK RD STE 215
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4112
Practice Address - Country:US
Practice Address - Phone:703-722-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist