1902131725 NPI number — DOMINION PHYSICAL THERAPY AND ASSOCIATES INCORPORATED

Table of content: (NPI 1902131725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902131725 NPI number — DOMINION PHYSICAL THERAPY AND ASSOCIATES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINION PHYSICAL THERAPY AND ASSOCIATES INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902131725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
729 THIMBLE SHOALS BLVD
Provider Second Line Business Mailing Address:
SUITE 4A
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-4217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-597-9510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 MARCELLA RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-597-9510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
757-597-9510

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2305206151 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2305206151 . This is a "VA LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".