Basic Information
| Provider Information | |||||||||
| NPI: | 1205809506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY AT ACAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1583 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229021583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349827794 | ||||||||
| FaxNumber: | 4349827752 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 ALBEMARLE SQ | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229017405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348177848 | ||||||||
| FaxNumber: | 4349512194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | STARR | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4348177848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHYSCIAL THERAPY AT ACAC LLC | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225100000X | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 205318000 | 01 | DEPT OF LABOR | OTHER | 75273 | 01 | VA | COMMUNITY HEALTH | OTHER | 239853 | 01 | VA | SOUTHERN HEALTH | OTHER |