Provider Demographics
NPI:1902329683
Name:LENNON, ALESSA RAE (MA, ATC, PES)
Entity Type:Individual
Prefix:
First Name:ALESSA
Middle Name:RAE
Last Name:LENNON
Suffix:
Gender:F
Credentials:MA, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23187-0399
Mailing Address - Country:US
Mailing Address - Phone:757-221-3407
Mailing Address - Fax:
Practice Address - Street 1:751 UKROP WAY
Practice Address - Street 2:KAPLAN ARENA
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-221-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260024532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer