Provider Demographics
NPI:1528392651
Name:NORTHSIDE PHYSICAL THERAPY AND FITNESS, PLC
Entity Type:Organization
Organization Name:NORTHSIDE PHYSICAL THERAPY AND FITNESS, PLC
Other - Org Name:NORTHSIDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFFOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-964-0067
Mailing Address - Street 1:1770 TIMBERWOOD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7501
Mailing Address - Country:US
Mailing Address - Phone:434-964-0067
Mailing Address - Fax:243-964-0072
Practice Address - Street 1:1770 TIMBERWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7501
Practice Address - Country:US
Practice Address - Phone:434-964-0067
Practice Address - Fax:243-964-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty