Healthcare Provider Details

I. General information

NPI: 1487340360
Provider Name (Legal Business Name): POWER & GRACE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 CORPORATE PARK DR STE C
FOREST VA
24551-2268
US

IV. Provider business mailing address

203 MCMASTER RD
CONCORD VA
24538-3161
US

V. Phone/Fax

Practice location:
  • Phone: 434-944-0801
  • Fax:
Mailing address:
  • Phone: 434-944-0801
  • 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: DR. COURTNEY ANNE BUMGARNER
Title or Position: PHYSICAL THERAPIST
Credential: PT DPT
Phone: 434-944-0801