| NPI | 1649825779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing & Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2022-06-02 |