Healthcare Provider Details

I. General information

NPI: 1023101870
Provider Name (Legal Business Name): PHYSICAL THERAPY AT ACAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 ALBEMARLE SQ
CHARLOTTESVILLE VA
22901
US

IV. Provider business mailing address

PO BOX 1583
CHARLOTTESVILLE VA
22902-1583
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-4278
  • Fax: 434-817-4279
Mailing address:
  • Phone: 434-982-7794
  • Fax: 434-982-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name: KIMBERELY STARR
Title or Position: EXECUTIVE DIRECTOR
Credential: PT
Phone: 434-817-7848