MEDICARE: MIDLOTHIAN ORTHOPEDIC SPORTS THERAPY

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	225100000X	Physical Therapist	2305002803	VA

General Provider Information

NPI Number	:	1891702783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLOTHIAN ORTHOPEDIC SPORTS THERAPY

Provider Business Mailing Address
First Line	:	2240 OAK LAKE BOULEVARD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-0000
Country	:	US
Telephone Number	:	804-794-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 OAK LAKE BOULEVARD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-0000
Country	:	US
Telephone Number	:	804-794-9023
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGG A TOBEY
Credential	:	PT
Telephone Number	:	804-794-9023

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	08/22/2020

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Directions to “MIDLOTHIAN ORTHOPEDIC SPORTS THERAPY ” Practice Location

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