Basic Information
Provider Information | |||||||||
NPI: | 1144259334 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PHYSICAL THERAPY SOLUTIONS PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8201 ATLEE ROAD | ||||||||
Address2: | SUITE D | ||||||||
City: | MECHANICSVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 23116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045691787 | ||||||||
FaxNumber: | 8045699787 | ||||||||
Practice Location | |||||||||
Address1: | 8201 ATLEE ROAD | ||||||||
Address2: | SUITE D | ||||||||
City: | MECHANICSVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 23116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045691787 | ||||||||
FaxNumber: | 8045699787 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/01/2006 | ||||||||
LastUpdateDate: | 05/29/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PIETRUSZKIEWICZ | ||||||||
AuthorizedOfficialFirstName: | ALAN | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
AuthorizedOfficialTelephone: | 8045691787 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MSPT | ||||||||
NPICertificationDate: |   |
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 |   |
ID Information
ID | Type | State | Issuer | Description | DE5332 | 01 |   | RR MEDICARE | OTHER | 192348 | 01 | VA | ANTHEM BS | OTHER |