Provider Demographics
NPI:1205809506
Name:PHYSICAL THERAPY AT ACAC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AT ACAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-817-7848
Mailing Address - Street 1:504 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7405
Mailing Address - Country:US
Mailing Address - Phone:434-817-7848
Mailing Address - Fax:434-465-6834
Practice Address - Street 1:504 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7405
Practice Address - Country:US
Practice Address - Phone:434-817-7848
Practice Address - Fax:434-951-2194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSCIAL THERAPY AT ACAC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-08
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XH1200X, 235Z00000X
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
205318000OtherDEPT OF LABOR
VA239853OtherSOUTHERN HEALTH
VA75273OtherCOMMUNITY HEALTH
VA239853OtherSOUTHERN HEALTH
VA75273OtherCOMMUNITY HEALTH
205318000OtherDEPT OF LABOR