1851484448 NPI number — CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE, PC

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 1851484448 NPI number — CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE, PC
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:
1851484448
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:
3920 SPRINGFIELD RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-747-7472
Provider Business Mailing Address Fax Number:
804-747-7441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3920 SPRINGFIELD RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-747-7472
Provider Business Practice Location Address Fax Number:
804-747-7441
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAFEEI
Authorized Official First Name:
TOURAGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
804-747-7472

Provider Taxonomy Codes

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

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





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