Provider Demographics
NPI:1912171604
Name:GAIT CENTER HAMPTON ROADS
Entity Type:Organization
Organization Name:GAIT CENTER HAMPTON ROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:GLISSON
Authorized Official - Last Name:ARNTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:804-523-2653
Mailing Address - Street 1:6325 N CENTER DR
Mailing Address - Street 2:BUILDING 18, SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4010
Mailing Address - Country:US
Mailing Address - Phone:804-523-2653
Mailing Address - Fax:804-783-8212
Practice Address - Street 1:6325 N CENTER DR
Practice Address - Street 2:BUILDING 18, SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4010
Practice Address - Country:US
Practice Address - Phone:804-523-2653
Practice Address - Fax:804-783-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004517261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy