Provider Demographics
NPI:1477048973
Name:PTC WELLNESS CENTERS BWXT
Entity Type:Organization
Organization Name:PTC WELLNESS CENTERS BWXT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:TATOM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:434-455-1550
Mailing Address - Street 1:PO BOX 785 MAIL STOP 66
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24505
Mailing Address - Country:US
Mailing Address - Phone:434-522-5006
Mailing Address - Fax:434-522-5991
Practice Address - Street 1:1570 MT. ATHOS RD.
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504
Practice Address - Country:US
Practice Address - Phone:434-522-5006
Practice Address - Fax:434-522-5991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PTC WELLNESS CENTERS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty