Provider Demographics
NPI:1356311880
Name:PENINSULA PHYSICAL THERAPY & ASSOCIATES, INC
Entity Type:Organization
Organization Name:PENINSULA PHYSICAL THERAPY & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:757-838-7453
Mailing Address - Street 1:1618 HARDY CASH DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2400
Mailing Address - Country:US
Mailing Address - Phone:757-838-7453
Mailing Address - Fax:757-838-2314
Practice Address - Street 1:1618 HARDY CASH DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2400
Practice Address - Country:US
Practice Address - Phone:757-838-7453
Practice Address - Fax:757-838-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001701261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4979397Medicaid
VA496644Medicare Oscar/Certification