Provider Demographics
NPI:1821860081
Name:SPA HOME HEALTH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SPA HOME HEALTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:843-473-5467
Mailing Address - Street 1:4445 CORPORATION LN STE 264
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4445 CORPORATION LN STE 264
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3671
Practice Address - Country:US
Practice Address - Phone:843-473-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health