Provider Demographics
NPI:1851781769
Name:RVA PHYSICAL THERAPY& SPORTS REHAB, LLC
Entity Type:Organization
Organization Name:RVA PHYSICAL THERAPY& SPORTS REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMAKRISHNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVASERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:804-874-2476
Mailing Address - Street 1:2620 GASKINS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1402
Mailing Address - Country:US
Mailing Address - Phone:804-396-6753
Mailing Address - Fax:888-815-8184
Practice Address - Street 1:2620 GASKINS RD STE A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-1402
Practice Address - Country:US
Practice Address - Phone:804-396-6753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204964261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation