| NPI | 1841649068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing & Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0102204066) |
| 207X00000X Orthopaedic Surgery | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2023-08-17 |