Provider Demographics
NPI:1699175810
Name:BOTETOURT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BOTETOURT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-992-3660
Mailing Address - Street 1:104 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-2575
Mailing Address - Country:US
Mailing Address - Phone:540-992-3660
Mailing Address - Fax:
Practice Address - Street 1:104 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2575
Practice Address - Country:US
Practice Address - Phone:540-992-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207120261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy