Provider Demographics
NPI:1609081256
Name:PERSONAL PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:PERSONAL PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-450-0680
Mailing Address - Street 1:480 W. JUBAL EARLY DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-450-0680
Mailing Address - Fax:540-450-0681
Practice Address - Street 1:480 W. JUBAL EARLY DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6449
Practice Address - Country:US
Practice Address - Phone:540-450-0680
Practice Address - Fax:540-450-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305831302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10230Medicare PIN