Provider Demographics
NPI:1164086625
Name:ASPEN PHYSICAL MEDICINE, LLC
Entity Type:Organization
Organization Name:ASPEN PHYSICAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-492-4222
Mailing Address - Street 1:2110 CAROLINA AVE SW FL 2
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1742
Mailing Address - Country:US
Mailing Address - Phone:540-492-4222
Mailing Address - Fax:540-343-0056
Practice Address - Street 1:2110 CAROLINA AVE SW FL 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1742
Practice Address - Country:US
Practice Address - Phone:540-492-4222
Practice Address - Fax:540-343-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty