Provider Demographics
NPI:1528004041
Name:ABERCROMBIE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:ABERCROMBIE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:ABERCROMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-799-6100
Mailing Address - Street 1:2811 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4117
Mailing Address - Country:US
Mailing Address - Phone:434-799-6100
Mailing Address - Fax:434-799-1116
Practice Address - Street 1:2811 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4117
Practice Address - Country:US
Practice Address - Phone:434-799-6100
Practice Address - Fax:434-799-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08582Medicare ID - Type Unspecified
VA4684740001Medicare NSC