Provider Demographics
NPI:1912590811
Name:ONWARD RICHMOND, LLC
Entity Type:Organization
Organization Name:ONWARD RICHMOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-509-9748
Mailing Address - Street 1:4910 ROSEWELL DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3629
Mailing Address - Country:US
Mailing Address - Phone:757-509-9748
Mailing Address - Fax:
Practice Address - Street 1:312 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4225
Practice Address - Country:US
Practice Address - Phone:804-655-6327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305207513OtherPT LICENSE