Individual
ILANA NICOLE KELLOGG WAASDORP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1421 3RD ST SW, ROANOKE, VA 24016-5204
(303) 900-3457
Mailing address
1421 3RD ST SW, ROANOKE, VA 24016-5204
(303) 900-3457
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PTL.0012174
CO
2251P0200X
Pediatric Physical Therapist
Primary
2305212941
VA
Other
Enumeration date
06/03/2013
Last updated
01/02/2020
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