Provider Demographics
NPI:1902221740
Name:PURCELLVILLE ORTHOPEDIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PURCELLVILLE ORTHOPEDIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:FORBES
Authorized Official - Last Name:COX
Authorized Official - Suffix:III
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:301-788-2768
Mailing Address - Street 1:850C E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3163
Mailing Address - Country:US
Mailing Address - Phone:540-751-1970
Mailing Address - Fax:540-751-1971
Practice Address - Street 1:850C E MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3163
Practice Address - Country:US
Practice Address - Phone:540-751-1970
Practice Address - Fax:540-751-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy