Healthcare Provider Details

I. General information

NPI: 1619573045
Provider Name (Legal Business Name): VIKKI NATASHA GAINES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300B TEMPLE LAKE DR STE 101
COLONIAL HEIGHTS VA
23834-2973
US

IV. Provider business mailing address

7224 WALKING HORSE DR
MECHANICSVILLE VA
23111-1955
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-9036
  • Fax: 804-524-9039
Mailing address:
  • Phone: 804-683-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: