Provider Demographics
NPI:1083609507
Name:ADVANCED PAIN AND ORTHOPEDIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED PAIN AND ORTHOPEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SWINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:540-548-4300
Mailing Address - Street 1:1320 CENTRAL PARK BLVD
Mailing Address - Street 2:#405
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4942
Mailing Address - Country:US
Mailing Address - Phone:540-548-4300
Mailing Address - Fax:540-548-1430
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:#405
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:540-548-4300
Practice Address - Fax:540-548-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09173Medicare ID - Type Unspecified