Provider Demographics
NPI:1750037610
Name:INDEPENDENCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INDEPENDENCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLADDYS
Authorized Official - Middle Name:O
Authorized Official - Last Name:PASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-497-7575
Mailing Address - Street 1:762 INDEPENDENCE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6200
Mailing Address - Country:US
Mailing Address - Phone:757-497-7575
Mailing Address - Fax:757-490-1795
Practice Address - Street 1:762 INDEPENDENCE BLVD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6200
Practice Address - Country:US
Practice Address - Phone:757-497-7575
Practice Address - Fax:757-490-1795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENCE PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty