Provider Demographics
NPI:1437638996
Name:DRISCOLL, EMILY KATHLEEN (PT)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KATHLEEN
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 FOREST HILL AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6877
Mailing Address - Country:US
Mailing Address - Phone:804-985-1234
Mailing Address - Fax:
Practice Address - Street 1:9211 FOREST HILL AVE APT 302
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6874
Practice Address - Country:US
Practice Address - Phone:804-985-1234
Practice Address - Fax:183-338-9170
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist