Provider Demographics
NPI:1164479721
Name:LENOIR, BETTY RAGON (PT,DPT)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:RAGON
Last Name:LENOIR
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:LOVE
Other - Last Name:RAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2313 WATERS MILL CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2921
Mailing Address - Country:US
Mailing Address - Phone:731-609-6293
Mailing Address - Fax:
Practice Address - Street 1:2313 WATERS MILL CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-2921
Practice Address - Country:US
Practice Address - Phone:731-609-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN632225100000X
VACPO39665T2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare ID - Type UnspecifiedGROUP