Provider Demographics
NPI:1295178424
Name:VELOCITY PHYSICAL THERAPY,LLC
Entity Type:Organization
Organization Name:VELOCITY PHYSICAL THERAPY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:MULHALL
Authorized Official - Last Name:DIETZGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-763-3522
Mailing Address - Street 1:321 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3908
Mailing Address - Country:US
Mailing Address - Phone:910-763-3522
Mailing Address - Fax:910-763-3521
Practice Address - Street 1:321 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3908
Practice Address - Country:US
Practice Address - Phone:910-763-3522
Practice Address - Fax:910-763-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty