Provider Demographics
NPI:1275707093
Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS
Entity Type:Organization
Organization Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS
Other - Org Name:NEW RIVER LEAGUE OF THERAPISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:HR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-984-0023
Mailing Address - Street 1:7350 PEPPERS FERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24141-8856
Mailing Address - Country:US
Mailing Address - Phone:540-633-3816
Mailing Address - Fax:540-633-3819
Practice Address - Street 1:7350 PEPPERS FERRY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-8856
Practice Address - Country:US
Practice Address - Phone:540-633-3816
Practice Address - Fax:540-633-3819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTESVILLE LEAGUE OF THERAPISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA411-05-001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services