Provider Demographics
NPI:1649337874
Name:ALBEMARLE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ALBEMARLE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-817-0980
Mailing Address - Street 1:285 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8126
Mailing Address - Country:US
Mailing Address - Phone:434-817-0980
Mailing Address - Fax:434-817-0985
Practice Address - Street 1:285 HYDRAULIC RIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8126
Practice Address - Country:US
Practice Address - Phone:434-817-0980
Practice Address - Fax:434-817-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06823Medicare UPIN