Provider Demographics
NPI:1205131810
Name:PINNACLE PHYSICAL THERAPY& SPORTS MEDICINE
Entity type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY& SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBERSHIP
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:PT, C PED, CSCS
Authorized Official - Phone:276-238-8900
Mailing Address - Street 1:106 W STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2114
Mailing Address - Country:US
Mailing Address - Phone:276-238-8900
Mailing Address - Fax:
Practice Address - Street 1:1340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-3437
Practice Address - Country:US
Practice Address - Phone:276-238-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty