Provider Demographics
NPI:1073573242
Name:DOMINION PHYSICAL THERAPY & ASSOCIATES INC.
Entity Type:Organization
Organization Name:DOMINION PHYSICAL THERAPY & ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-873-2932
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-873-2932
Mailing Address - Fax:
Practice Address - Street 1:304 MARCELLA ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-825-9446
Practice Address - Fax:757-825-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978935Medicaid
VA496616Medicare ID - Type Unspecified