Provider Demographics
NPI:1376536441
Name:ORTHOPEDIC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ORTHOPEDIC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT OCS
Authorized Official - Phone:804-285-0148
Mailing Address - Street 1:2000 BREMO RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2440
Mailing Address - Country:US
Mailing Address - Phone:804-285-0148
Mailing Address - Fax:804-673-6026
Practice Address - Street 1:2000 BREMO RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2440
Practice Address - Country:US
Practice Address - Phone:804-285-0148
Practice Address - Fax:804-673-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087525OtherBC/BS
VA087525OtherBC/BS