Provider Demographics
NPI:1629079967
Name:PHYSIOTECH INC.
Entity Type:Organization
Organization Name:PHYSIOTECH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-273-9721
Mailing Address - Street 1:3420 PUMP RD
Mailing Address - Street 2:#104
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1111
Mailing Address - Country:US
Mailing Address - Phone:804-273-9721
Mailing Address - Fax:804-273-1065
Practice Address - Street 1:10712 SHADYFORD LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6271
Practice Address - Country:US
Practice Address - Phone:804-273-9721
Practice Address - Fax:804-273-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017907786332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies