Provider Demographics
NPI:1851492599
Name:CENTRA HEALTH INC
Entity Type:Organization
Organization Name:CENTRA HEALTH INC
Other - Org Name:PHYSICAL AND OCCUPATIONAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:SRVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-947-4708
Mailing Address - Street 1:PO BOX 2496
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24505-2496
Mailing Address - Country:US
Mailing Address - Phone:434-947-3777
Mailing Address - Fax:434-947-4763
Practice Address - Street 1:1204 FENWICK DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2112
Practice Address - Country:US
Practice Address - Phone:434-947-3777
Practice Address - Fax:434-947-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189963OtherANTHEM
VA189959OtherANTHEM
VA189972OtherANTHEM
VA189990OtherANTHEM