Provider Demographics
NPI:1093887390
Name:VIRGINIA THERAPY & FITNESS CENTER
Entity Type:Organization
Organization Name:VIRGINIA THERAPY & FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-709-1114
Mailing Address - Street 1:PO BOX 162463
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2463
Mailing Address - Country:US
Mailing Address - Phone:703-709-1116
Mailing Address - Fax:703-709-5134
Practice Address - Street 1:11800 SUNRISE VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5309
Practice Address - Country:US
Practice Address - Phone:703-709-1116
Practice Address - Fax:703-709-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2024-01-05
Deactivation Date:2023-12-26
Deactivation Code:
Reactivation Date:2024-01-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy