Provider Demographics
NPI:1477569200
Name:POWHATAN PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:POWHATAN PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOBEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-794-9023
Mailing Address - Street 1:1799 SOUTHCREEK ONE
Mailing Address - Street 2:SUITE E
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7953
Mailing Address - Country:US
Mailing Address - Phone:804-794-9023
Mailing Address - Fax:804-794-9373
Practice Address - Street 1:1799 SOUTHCREEK ONE
Practice Address - Street 2:SUITE E
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7953
Practice Address - Country:US
Practice Address - Phone:804-794-9023
Practice Address - Fax:804-794-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty