Provider Demographics
NPI:1609838242
Name:AMELIA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:AMELIA PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-561-1585
Mailing Address - Street 1:10130 SUPERIOR WAY
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4744
Mailing Address - Country:US
Mailing Address - Phone:804-561-1585
Mailing Address - Fax:804-561-7430
Practice Address - Street 1:10130 SUPERIOR WAY
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4744
Practice Address - Country:US
Practice Address - Phone:804-561-1585
Practice Address - Fax:804-561-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA235571OtherALLIANCE PPO PROVIDER NUM
VA280550OtherSOUTHERN HEALTH PROVIDER
VA460947OtherANTHEM PROVIDER NUMBER
VA7954419OtherAETNA PROVIDER NUMBER
VA010187095Medicaid
VADB7288OtherRAIL ROAD MEDICARE
VADB7288OtherRAIL ROAD MEDICARE