Individual
LARONDA VIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 GARDNER DR, WILMINGTON, NC 28405-8873
(910) 343-5300
Mailing address
1705 GARDNER DR, WILMINGTON, NC 28405-8873
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5712
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A5792
LICENSE
NC
Enumeration date
09/17/2020
Last updated
09/17/2020
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