Provider Demographics
NPI:1841314440
Name:ESSEX PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ESSEX PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSPT
Authorized Official - Phone:804-443-4850
Mailing Address - Street 1:PO BOX 1401
Mailing Address - Street 2:900 SOUTH CHURCH LANE
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560
Mailing Address - Country:US
Mailing Address - Phone:804-443-4850
Mailing Address - Fax:804-443-4851
Practice Address - Street 1:900 SOUTH CHURCH LN
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-4850
Practice Address - Fax:804-443-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09695Medicare PIN