Basic Information
| Provider Information | |||||||||
| NPI: | 1043982390 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RADIUS PT OF VIRGINIA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEGACY PT OF VIRGINIA LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 563 UNIVERSITY BLVD STE 152 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405341338 | ||||||||
| FaxNumber: | 5403012773 | ||||||||
| Practice Location | |||||||||
| Address1: | 563 UNIVERSITY BLVD STE 152 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405341338 | ||||||||
| FaxNumber: | 5403012773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2021 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KEISLING | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CORPORATE OPERATINS | ||||||||
| AuthorizedOfficialTelephone: | 8434410595 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.