Provider Demographics
NPI:1750461299
Name:PHYSIOTHERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES INC
Other - Org Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:FLECK
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-467-8705
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-5245
Mailing Address - Country:US
Mailing Address - Phone:724-465-3496
Mailing Address - Fax:215-413-4682
Practice Address - Street 1:6315 N CENTER DR
Practice Address - Street 2:BLDG 20, STE 250, 2ND FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4006
Practice Address - Country:US
Practice Address - Phone:757-893-9210
Practice Address - Fax:757-893-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496662Medicare Oscar/Certification