Healthcare Provider Details

I. General information

NPI: 1932113776
Provider Name (Legal Business Name): ADVANTAGE PHYSICAL THERAPY & SPORTS PERFORMANCE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 LUCY DR A
HARRISONBURG VA
22801-8050
US

IV. Provider business mailing address

381 LUCY DR A
HARRISONBURG VA
22801-8050
US

V. Phone/Fax

Practice location:
  • Phone: 540-434-1200
  • Fax: 540-434-1203
Mailing address:
  • Phone: 540-434-1200
  • Fax: 540-434-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. WILLIAM MARSHALL JOHNSON
Title or Position: PRESIDENT/OWNER
Credential: DPT
Phone: 540-434-1200