Healthcare Provider Details

I. General information

NPI: 1578058632
Provider Name (Legal Business Name): CHARLOTTESVILLE PT PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ARLINGTON BLVD STE 100
CHARLOTTESVILLE VA
22903-1533
US

IV. Provider business mailing address

1924 ARLINGTON BLVD STE 100
CHARLOTTESVILLE VA
22903-1533
US

V. Phone/Fax

Practice location:
  • Phone: 434-984-0303
  • 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, SOLE MEMBER
Credential: PT
Phone: 434-242-8077