Healthcare Provider Details

I. General information

NPI: 1427429703
Provider Name (Legal Business Name): PT PLUS AT HERITAGE INN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PANTOPS DR
CHARLOTTESVILLE VA
22911-8674
US

IV. Provider business mailing address

804 AFTON MOUNTAIN RD
AFTON VA
22920-2408
US

V. Phone/Fax

Practice location:
  • Phone: 434-242-8077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA COLEMAN
Title or Position: OWNER
Credential: PT
Phone: 540-456-4677