Healthcare Provider Details

I. General information

NPI: 1174938393
Provider Name (Legal Business Name): COURTLAND HEARING AIDS AND BALANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22730 MAIN ST
COURTLAND VA
23837-1127
US

IV. Provider business mailing address

26089 GUY PLACE RD
COURTLAND VA
23837-2745
US

V. Phone/Fax

Practice location:
  • Phone: 757-653-7532
  • Fax:
Mailing address:
  • Phone: 757-653-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number2101001409
License Number StateVA

VIII. Authorized Official

Name: MRS. CHERYL ANN WRAY
Title or Position: OWNER
Credential:
Phone: 757-653-7658