Basic Information
| Provider Information | |||||||||
| NPI: | 1609894450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOVIRGINIA, INC. | ||||||||
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| OtherOrganizationName: | COMMONWEALTH ORTHOPAEDICS & REHABILITATION PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 715868 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191715868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049151910 | ||||||||
| FaxNumber: | 7036914933 | ||||||||
| Practice Location | |||||||||
| Address1: | 6355 WALKER LANE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223103257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039212167 | ||||||||
| FaxNumber: | 7038105494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | PROFFITT | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING & ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 8045332357 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.