MEDICARE: VIRGINIA HIGHLANDS SPINE REHABILITATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2305203605	VA
2	2251X0800X	Orthopedic Physical Therapist	2305203114	VA

General Provider Information

NPI Number	:	1538466354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA HIGHLANDS SPINE REHABILITATION

Provider Business Mailing Address
First Line	:	178 W MAIN ST
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2330
Country	:	US
Telephone Number	:	276-228-3258
Fax Number	:	276-228-3630

Provider Business Practice Location Address
First Line	:	178 W MAIN ST
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2330
Country	:	US
Telephone Number	:	276-228-3258
Fax Number	:	276-228-3630

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DANIEL R PERRY
Credential	:	MPT, DIP, MDT
Telephone Number	:	276-773-8145

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	02/14/2011

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Directions to “VIRGINIA HIGHLANDS SPINE REHABILITATION ” Practice Location

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