Provider Demographics
NPI:1023101870
Name:PHYSICAL THERAPY AT ACAC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AT ACAC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERELY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-817-7848
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1583
Mailing Address - Country:US
Mailing Address - Phone:434-982-7794
Mailing Address - Fax:434-982-7752
Practice Address - Street 1:410 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-817-4278
Practice Address - Fax:434-817-4279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY AT ACAC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA75273OtherCOMMUNITY HEALTH
VA205318001OtherDEPT OF LABOR
VA3155448OtherUNITED HEALTHCAR MAMSI
VA239853OtherSOUTHERN HEALTH
VA197260OtherANTHEM SERVICES
VAC09125Medicare PIN
VA197260OtherANTHEM SERVICES
VA3155448OtherUNITED HEALTHCAR MAMSI