Provider Demographics
NPI:1154551547
Name:MCQUILLAN, LENORA SUE (CMT)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:SUE
Last Name:MCQUILLAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EMERY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-2705
Mailing Address - Country:US
Mailing Address - Phone:540-442-9711
Mailing Address - Fax:540-442-9781
Practice Address - Street 1:21 EMERY ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2705
Practice Address - Country:US
Practice Address - Phone:540-442-9711
Practice Address - Fax:540-442-9781
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019000287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist