Provider Demographics
NPI:1588005250
Name:PT PLUS AT OLD TRAIL, LLC
Entity Type:Organization
Organization Name:PT PLUS AT OLD TRAIL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-823-7628
Mailing Address - Street 1:804 AFTON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:VA
Mailing Address - Zip Code:22920-2408
Mailing Address - Country:US
Mailing Address - Phone:540-456-4677
Mailing Address - Fax:
Practice Address - Street 1:330 CLAREMONT LN
Practice Address - Street 2:SUITE 211
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3386
Practice Address - Country:US
Practice Address - Phone:434-823-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty