1659545473 NPI number — CHARLOTTESVILLE LEAGUE OF THERAPISTS

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 1659545473 NPI number — CHARLOTTESVILLE LEAGUE OF THERAPISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLOTTESVILLE LEAGUE OF THERAPISTS
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:
LYNCHBURG LEAGUE OF THERAPISTS
Provider Other Organization Name Type Code:
5
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:
1659545473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
523 CLAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24504-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-455-7990
Provider Business Mailing Address Fax Number:
434-455-0256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 CLAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24504-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-455-7990
Provider Business Practice Location Address Fax Number:
434-455-0256
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
HR ASSISTANT
Authorized Official Telephone Number:
434-984-0023

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  41105001 , 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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