Healthcare Provider Details

I. General information

NPI: 1609838242
Provider Name (Legal Business Name): AMELIA PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 SUPERIOR WAY
AMELIA COURT HOUSE VA
23002-4744
US

IV. Provider business mailing address

10130 SUPERIOR WAY
AMELIA COURT HOUSE VA
23002-4744
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-1585
  • Fax: 804-561-7430
Mailing address:
  • Phone: 804-561-1585
  • Fax: 804-561-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006161
License Number StateVA

VIII. Authorized Official

Name: MR. BENSON WALKER HOWARD
Title or Position: PRESIDENT
Credential: P.T.
Phone: 804-561-1585