Provider Demographics
NPI:1831548189
Name:LETARD, DELANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:DELANIE
Middle Name:
Last Name:LETARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DELANIE
Other - Middle Name:
Other - Last Name:ALPHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:10128 W BROAD ST
Practice Address - Street 2:FORUM BLDG III, SUITE K
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6761
Practice Address - Country:US
Practice Address - Phone:804-217-9210
Practice Address - Fax:804-217-9213
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01704964OtherMEDICARE RAILROAD PTAN
VAC05954OtherGROUP MEDICARE PTAN
VA1831548189OtherMEDICAID QMB PROVIDER ID
VAC05954OtherGROUP MEDICARE PTAN