| NPI | 1265470645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing & Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 225X00000X Occupational Therapist | |
| 261QP2000X Clinic/Center Physical Therapy | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2025-09-02 |