Provider Demographics
NPI:1114070935
Name:WEST POINT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WEST POINT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:804-843-9033
Mailing Address - Street 1:100 WINTERS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23181-9534
Mailing Address - Country:US
Mailing Address - Phone:804-843-9033
Mailing Address - Fax:804-843-9037
Practice Address - Street 1:100 WINTERS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181-9534
Practice Address - Country:US
Practice Address - Phone:804-843-9033
Practice Address - Fax:804-843-9037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANOVER REHABILITATION ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
012207H26Medicare PIN