Healthcare Provider Details

I. General information

NPI: 1508636028
Provider Name (Legal Business Name): PHYSICAL THERAPY AT ACAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ALBEMARLE SQUARE
CHARLOTTESVILLE VA
22901
US

IV. Provider business mailing address

504 ALBEMARLE SQ
CHARLOTTESVILLE VA
22901-7405
US

V. Phone/Fax

Practice location:
  • Phone: 434-443-0295
  • Fax: 434-465-6843
Mailing address:
  • Phone: 434-817-7848
  • Fax: 434-465-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE NERI
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 434-817-7848