Provider Demographics
NPI:1922104439
Name:LETELLIER, KAREN (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LETELLIER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3920 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4119
Mailing Address - Country:US
Mailing Address - Phone:804-747-7472
Mailing Address - Fax:804-747-7441
Practice Address - Street 1:5716 CLEVELAND ST STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1784
Practice Address - Country:US
Practice Address - Phone:757-961-7271
Practice Address - Fax:757-961-7276
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011165T79Medicare ID - Type UnspecifiedVIRGINIA MEDICARE