Healthcare Provider Details

I. General information

NPI: 1063980449
Provider Name (Legal Business Name): ERIC ZWARYCZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 JAMES MADISON HWY
FORK UNION VA
23055
US

IV. Provider business mailing address

2111 WOODMAN OAKS LN
POWHATAN VA
23139-7139
US

V. Phone/Fax

Practice location:
  • Phone: 434-842-2916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604716
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: