Provider Demographics
NPI:1760664775
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC.,
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC.,
Other - Org Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY ASSOC., INC. DIV OF PRATT MED CTR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-373-3031
Mailing Address - Street 1:421 CHATHAM SQUARE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2561
Mailing Address - Country:US
Mailing Address - Phone:540-373-3031
Mailing Address - Fax:540-373-9174
Practice Address - Street 1:2800 WELLFORD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3176
Practice Address - Country:US
Practice Address - Phone:540-373-6320
Practice Address - Fax:540-373-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01407Medicare PIN