Provider Demographics
NPI:1891817938
Name:PREMIER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:SLEZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:540-785-9770
Mailing Address - Street 1:6330 FIVE MILE CENTRE PARK
Mailing Address - Street 2:#406
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-5516
Mailing Address - Country:US
Mailing Address - Phone:540-785-9770
Mailing Address - Fax:540-785-9772
Practice Address - Street 1:6330 FIVE MILE CENTRE PARK
Practice Address - Street 2:#406
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5516
Practice Address - Country:US
Practice Address - Phone:540-785-9770
Practice Address - Fax:540-785-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202232261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy