Provider Demographics
NPI:1972556199
Name:DUFFIELD PHYSICAL THERAPY AND FITNESS
Entity Type:Organization
Organization Name:DUFFIELD PHYSICAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWAYNE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:1276-356-2701
Mailing Address - Street 1:134 CECIL D QUILLEN DR
Mailing Address - Street 2:
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244-9726
Mailing Address - Country:US
Mailing Address - Phone:276-431-3141
Mailing Address - Fax:276-431-3143
Practice Address - Street 1:134 CECIL D QUILLEN DR
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-9726
Practice Address - Country:US
Practice Address - Phone:276-431-3141
Practice Address - Fax:276-431-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty