Provider Demographics
NPI:1487813705
Name:SECUNDA, LIANNE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:LIANNE
Middle Name:
Last Name:SECUNDA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7302
Mailing Address - Country:US
Mailing Address - Phone:757-474-7490
Mailing Address - Fax:757-474-7931
Practice Address - Street 1:4142 BONNEY RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1711
Practice Address - Country:US
Practice Address - Phone:757-340-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant