Provider Demographics
NPI:1841659869
Name:VALENZUELA, YAISA
Entity type:Individual
Prefix:
First Name:YAISA
Middle Name:
Last Name:VALENZUELA
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 1:4560 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7905
Mailing Address - Country:US
Mailing Address - Phone:757-474-1249
Mailing Address - Fax:
Practice Address - Street 1:4560 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7905
Practice Address - Country:US
Practice Address - Phone:757-474-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2025-02-12
Deactivation Date:2021-10-05
Deactivation Code:
Reactivation Date:2025-02-12
Provider Licenses
StateLicense IDTaxonomies
VA2306602963225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant