1558441220 NPI number — PHYSICAL THERAPY CENTER OF CHESAPEAKE PLC

Table of content: (NPI 1558441220)

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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