1558441220 NPI number — PHYSICAL THERAPY CENTER OF CHESAPEAKE PLC

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 1558441220 NPI number — PHYSICAL THERAPY CENTER OF CHESAPEAKE PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY CENTER OF CHESAPEAKE PLC
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:
1558441220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 VOLVO PKWY
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
CHASAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-420-2880
Provider Business Mailing Address Fax Number:
757-420-8090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 VOLVO PKWY
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
CHASAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-420-2880
Provider Business Practice Location Address Fax Number:
757-420-8090
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUD
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PT OWNER
Authorized Official Telephone Number:
757-420-2880

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)

  • Identifier: 2138099 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 615185 . This is a "MAMSI OPTIMUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57767 . This is a "OPTIMA SENTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6400296 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3223253 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 615185 . This is a "ALLIANCE INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DE4722 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 193561 . This is a "HEALTH KEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 193561 . This is a "ANTHEM BLUECROSS BLUESHEI" identifier . This identifiers is of the category "OTHER".




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