Individual
DELANIE LETARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
10128 W BROAD ST, FORUM BLDG III, SUITE K, GLEN ALLEN, VA 23060-6761
(804) 217-9210
(804) 217-9213
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305210340
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831548189
MEDICAID QMB PROVIDER ID
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
01
—
P01704964
MEDICARE RAILROAD PTAN
VA
Enumeration date
06/08/2016
Last updated
03/08/2023
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