Provider Demographics
NPI:1538466354
Name:VIRGINIA HIGHLANDS SPINE REHABILITATION
Entity Type:Organization
Organization Name:VIRGINIA HIGHLANDS SPINE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, DIP, MDT
Authorized Official - Phone:276-773-8145
Mailing Address - Street 1:178 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2330
Mailing Address - Country:US
Mailing Address - Phone:276-228-3258
Mailing Address - Fax:276-228-3630
Practice Address - Street 1:178 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2330
Practice Address - Country:US
Practice Address - Phone:276-228-3258
Practice Address - Fax:276-228-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052031142251X0800X
VA23052036052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty