1609838242 NPI number — AMELIA PHYSICAL THERAPY INC

Table of content: (NPI 1609838242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609838242 NPI number — AMELIA PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMELIA PHYSICAL THERAPY INC
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:
1609838242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10130 SUPERIOR WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMELIA COURT HOUSE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23002-4744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-561-1585
Provider Business Mailing Address Fax Number:
804-561-7430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10130 SUPERIOR WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMELIA COURT HOUSE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23002-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-561-1585
Provider Business Practice Location Address Fax Number:
804-561-7430
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
BENSON
Authorized Official Middle Name:
WALKER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
804-561-1585

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305006161 , 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: 235571 . This is a "ALLIANCE PPO PROVIDER NUM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 280550 . This is a "SOUTHERN HEALTH PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 460947 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7954419 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010187095 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB7288 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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