Healthcare Provider Details

I. General information

NPI: 1174544431
Provider Name (Legal Business Name): TUCKAHOE PHYSICAL THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 BROAD STREET RD
MANAKIN SABOT VA
23103-2213
US

IV. Provider business mailing address

32 BROAD STREET RD
MANAKIN SABOT VA
23103-2213
US

V. Phone/Fax

Practice location:
  • Phone: 804-784-7090
  • Fax: 804-784-7092
Mailing address:
  • Phone: 804-784-7090
  • Fax: 804-784-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH S SUTTER
Title or Position: PRESIDENT
Credential: MSPT
Phone: 804-784-7090