1033285325 NPI number — MS. EDWINA M ADDISON PTA PHYSICAL THERAPI

Table of content: MS. EDWINA M ADDISON PTA PHYSICAL THERAPI (NPI 1033285325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033285325 NPI number — MS. EDWINA M ADDISON PTA PHYSICAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADDISON
Provider First Name:
EDWINA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PTA PHYSICAL THERAPI
Provider Gender Code:
F

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:
1033285325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 REMINGTON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
22903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-361-2650
Provider Business Mailing Address Fax Number:
434-361-2511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543 BEECH GROVE ROAD
Provider Second Line Business Practice Location Address:
NELSON PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
ROSELAND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-361-2650
Provider Business Practice Location Address Fax Number:
434-361-2511
Provider Enumeration Date:
11/28/2006

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: 224Z00000X , with the licence number:  2306602062 , 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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