Healthcare Provider Details

I. General information

NPI: 1134148059
Provider Name (Legal Business Name): ALAN LOMBARDO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 EASTSHORE DR STE 200
GLEN ALLEN VA
23059-5755
US

IV. Provider business mailing address

140 EASTSHORE DR STE 200
GLEN ALLEN VA
23059-5755
US

V. Phone/Fax

Practice location:
  • Phone: 804-441-2450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT015674
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: