Healthcare Provider Details

I. General information

NPI: 1629246350
Provider Name (Legal Business Name): LOUISA PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 JEFFERSON HWY SUITE 102
LOUISA VA
23093-6563
US

IV. Provider business mailing address

115 JEFFERSON HWY SUITE 102
LOUISA VA
23093-6563
US

V. Phone/Fax

Practice location:
  • Phone: 540-967-1757
  • Fax: 540-967-0817
Mailing address:
  • Phone: 540-967-1757
  • Fax: 540-967-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA SOUDERS
Title or Position: PRESIDENT
Credential:
Phone: 540-967-1757