Healthcare Provider Details

I. General information

NPI: 1326208604
Provider Name (Legal Business Name): SPECTRUM MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRIDGE ST STE 300
DANVILLE VA
24541-1222
US

IV. Provider business mailing address

109 BRIDGE ST STE 300
DANVILLE VA
24541-1222
US

V. Phone/Fax

Practice location:
  • Phone: 434-793-4711
  • Fax: 434-797-2514
Mailing address:
  • Phone: 434-793-4711
  • Fax: 434-797-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002703
License Number StateVA

VIII. Authorized Official

Name: DR. MARK C HERMANN
Title or Position: PHYSICIAN
Credential: MD
Phone: 434-793-4711