| NPI | 1831751148 |
|---|---|
| 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 |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2022-06-03 |