1720266935 NPI number — ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC.,

Table of content: (NPI 1720266935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720266935 NPI number — ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC.,
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:
ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC., INC.DIV OF PRATT MED
Provider Other Organization Name Type Code:
4
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:
1720266935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 CHATHAM SQUARE OFFICE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22405-2561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-373-3031
Provider Business Mailing Address Fax Number:
540-373-9174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9530 COSNER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22408-8709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-898-9141
Provider Business Practice Location Address Fax Number:
540-898-3358
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RETTER
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE SUPERVISOR
Authorized Official Telephone Number:
540-373-3031

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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