Provider Demographics
NPI:1396874244
Name:HARDWICK, JOSEPHINE V (PT)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:V
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 TURNER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5925
Mailing Address - Country:US
Mailing Address - Phone:404-918-4010
Mailing Address - Fax:
Practice Address - Street 1:4915 TURNER RIDGE CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5925
Practice Address - Country:US
Practice Address - Phone:404-918-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211032225100000X, 2251P0200X
GAPT002083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000912865AMedicaid