1437252210 NPI number — MRS. CORA TYSON HUITT MA, PT

Table of content: MRS. CORA TYSON HUITT MA, PT (NPI 1437252210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437252210 NPI number — MRS. CORA TYSON HUITT MA, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUITT
Provider First Name:
CORA
Provider Middle Name:
TYSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, PT
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:
1437252210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 CLARKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-213-0082
Provider Business Mailing Address Fax Number:
804-213-0528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 HUGUENOT RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-379-3002
Provider Business Practice Location Address Fax Number:
804-379-3053
Provider Enumeration Date:
09/06/2006

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: 225100000X , with the licence number:  2305001184 , 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: 192292 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2305001184 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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