Provider Demographics
NPI:1134309636
Name:DAMIEN HOWELL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DAMIEN HOWELL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT,OCS
Authorized Official - Phone:804-594-0403
Mailing Address - Street 1:1811 HUGUENOT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-5600
Mailing Address - Country:US
Mailing Address - Phone:804-594-0403
Mailing Address - Fax:804-594-0319
Practice Address - Street 1:1811 HUGUENOT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-5600
Practice Address - Country:US
Practice Address - Phone:804-594-0403
Practice Address - Fax:804-594-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305000840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08752Medicare PIN