Basic Information
Provider Information
NPI: 1003001983
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SADDHRA
FirstName: RORIE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: REYES
OtherFirstName: RORIE
OtherMiddleName: FERNANDEZ
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 1
Mailing Information
Address1: 290 COMMONS PKWY
Address2:  
City: DALEVILLE
State: VA
PostalCode: 240831707
CountryCode: US
TelephoneNumber: 5409660056
FaxNumber:  
Practice Location
Address1: 290 COMMONS PKWY
Address2:  
City: DALEVILLE
State: VA
PostalCode: 240831707
CountryCode: US
TelephoneNumber: 5409660056
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2007
LastUpdateDate: 02/05/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT019019PAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X2305206106VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X11284NCN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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