Provider Demographics
NPI:1366681595
Name:PHYSICAL THERAPY ASSOCIATES OF STEPHENS CITY
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF STEPHENS CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T.
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:BUONOCORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-868-0408
Mailing Address - Street 1:1114 FAIRFAX PIKE
Mailing Address - Street 2:BOX #3
Mailing Address - City:WHITE POST
Mailing Address - State:VA
Mailing Address - Zip Code:22663-1839
Mailing Address - Country:US
Mailing Address - Phone:540-868-0408
Mailing Address - Fax:
Practice Address - Street 1:1114 FAIRFAX PIKE
Practice Address - Street 2:BOX #3
Practice Address - City:WHITE POST
Practice Address - State:VA
Practice Address - Zip Code:22663-1839
Practice Address - Country:US
Practice Address - Phone:540-868-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty