Provider Demographics
NPI:1750619490
Name:ENDRIES, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ENDRIES
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 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1749
Mailing Address - Country:US
Mailing Address - Phone:757-827-2481
Mailing Address - Fax:
Practice Address - Street 1:900 ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-1749
Practice Address - Country:US
Practice Address - Phone:757-827-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602674225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant