Basic Information
| Provider Information | |||||||||
| NPI: | 1376536441 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPEDIC PHYSICAL THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 BREMO RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850148 | ||||||||
| FaxNumber: | 8046736026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 BREMO RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850148 | ||||||||
| FaxNumber: | 8046736026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | ADLER | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8042850148 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS PT OCS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | VA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 087525 | 01 | VA | BC/BS | OTHER |