Healthcare Provider Details

I. General information

NPI: 1295961936
Provider Name (Legal Business Name): CHARLOTTESVILLE LEAGUE OF THERAPISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 MAGNOLIA AVE
BUENA VISTA VA
24416-3026
US

IV. Provider business mailing address

911 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5355
US

V. Phone/Fax

Practice location:
  • Phone: 540-264-0100
  • Fax:
Mailing address:
  • Phone: 434-984-0023
  • Fax: 434-984-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number411
License Number StateVA

VIII. Authorized Official

Name: FRANCES GREENSTEIN
Title or Position: DIRECTOR
Credential:
Phone: 434-984-0023