Provider Demographics
NPI:1871718072
Name:LASERNA, NOEL
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:LASERNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9788 LORRAINE CAROL WAY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2134
Mailing Address - Country:US
Mailing Address - Phone:703-339-0150
Mailing Address - Fax:
Practice Address - Street 1:5000 FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1246
Practice Address - Country:US
Practice Address - Phone:703-797-3869
Practice Address - Fax:703-820-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026914225100000X
VA2305204532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist