Provider Demographics
NPI:1558441220
Name:PHYSICAL THERAPY CENTER OF CHESAPEAKE PLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF CHESAPEAKE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LOUD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:757-420-2880
Mailing Address - Street 1:747 VOLVO PKWY
Mailing Address - Street 2:103
Mailing Address - City:CHASAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-420-2880
Mailing Address - Fax:757-420-8090
Practice Address - Street 1:747 VOLVO PKWY
Practice Address - Street 2:103
Practice Address - City:CHASAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-420-2880
Practice Address - Fax:757-420-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138099OtherFIRST HEALTH
615185OtherMAMSI OPTIMUM
57767OtherOPTIMA SENTERA
6400296OtherUNITED HEALTH CARE
3223253OtherAETNA
615185OtherALLIANCE INSURANCE
DE4722OtherRAILROAD MEDICARE
193561OtherHEALTH KEEPERS
193561OtherANTHEM BLUECROSS BLUESHEI
=========OtherCHOICE CARE NET
=========OtherPHCS INSURANCE
=========OtherMEDIPLUS
6400296OtherUNITED HEALTH CARE
=========OtherAARP
=========OtherMAIL HANDLERS
193561OtherHEALTH KEEPERS
3223253OtherAETNA
=========OtherBEECH ST
=========OtherHUMANA
=========OtherMEDIPLUS