Provider Demographics
NPI: | 1245784578 |
---|---|
Name: | PT PLUS OF AUGUSTA, LLC |
Entity type: | Organization |
Organization Name: | PT PLUS OF AUGUSTA, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | FRANCES |
Authorized Official - Last Name: | COLEMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 540-943-0078 |
Mailing Address - Street 1: | 201 OSAGE LN STE 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | WAYNESBORO |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22980-9316 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-943-0078 |
Mailing Address - Fax: | 540-943-0081 |
Practice Address - Street 1: | 201 OSAGE LN STE 3 |
Practice Address - Street 2: | |
Practice Address - City: | WAYNESBORO |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22980-9316 |
Practice Address - Country: | US |
Practice Address - Phone: | 540-943-0078 |
Practice Address - Fax: | 540-943-0081 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-03 |
Last Update Date: | 2024-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |