Provider Demographics
NPI:1568491744
Name:JAMES RIVER PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:JAMES RIVER PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIST
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:804-330-0936
Mailing Address - Street 1:9019 FOREST HILL AVE
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-330-0936
Mailing Address - Fax:804-330-0937
Practice Address - Street 1:9019 FOREST HILL AVE
Practice Address - Street 2:SUITE 4C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-330-0936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2007-08-28
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
VA191597OtherANTHEM BS
VAC09785Medicare PIN
C09785Medicare ID - Type Unspecified