1295875797 NPI number — ATLANTIC SPEECH THERAPY LLC

Table of content: (NPI 1295875797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295875797 NPI number — ATLANTIC SPEECH THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC SPEECH THERAPY LLC
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:
RHONDA R OSISEK
Provider Other Organization Name Type Code:
3
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:
1295875797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 FIRST COLONIAL RD
Provider Second Line Business Mailing Address:
SUITE 1811
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-3182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-422-6342
Provider Business Mailing Address Fax Number:
757-422-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 FIRST COLONIAL RD
Provider Second Line Business Practice Location Address:
SUITE 1811
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-3182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-422-6342
Provider Business Practice Location Address Fax Number:
757-422-6343
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSISEK
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
757-422-6342

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202003836 , 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: 195598 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 32105 . This is a "OPTIMA SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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