Provider Demographics
NPI:1740506039
Name:MORRIS, LARA ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:ANNE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 YORKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-9715
Mailing Address - Country:US
Mailing Address - Phone:434-974-7121
Mailing Address - Fax:
Practice Address - Street 1:491 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4869
Practice Address - Country:US
Practice Address - Phone:434-296-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist