| NPI | 1871136622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing/Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| 207X00000X Orthopaedic Surgery | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2023-08-17 |