1073045522 NPI number — DR. BRITTNEY PAIGE THROCKMORTON-SAMPLES PT, DPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073045522 NPI number — DR. BRITTNEY PAIGE THROCKMORTON-SAMPLES PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THROCKMORTON-SAMPLES
Provider First Name:
BRITTNEY
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THROCKMORTON
Provider Other First Name:
BRITTNEY
Provider Other Middle Name:
PAIGE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073045522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
174 EXECUTIVE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-797-1504
Provider Business Mailing Address Fax Number:
434-797-1506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 EXECUTIVE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-797-1504
Provider Business Practice Location Address Fax Number:
434-797-1506
Provider Enumeration Date:
04/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  230520515B , 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)





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