Provider Demographics
NPI:1851484448
Name:CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:CENTER FOR PHYSICAL THERAPY & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOURAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFEEI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT, OCS
Authorized Official - Phone:804-747-7472
Mailing Address - Street 1:3920 SPRINGFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-747-7472
Mailing Address - Fax:804-747-7441
Practice Address - Street 1:3920 SPRINGFIELD RD.
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-747-7472
Practice Address - Fax:804-747-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08956Medicare ID - Type Unspecified