Healthcare Provider Details

I. General information

NPI: 1417260209
Provider Name (Legal Business Name): MVPT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14265 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-6560
US

IV. Provider business mailing address

14265 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-6560
US

V. Phone/Fax

Practice location:
  • Phone: 804-464-2323
  • Fax: 804-464-2323
Mailing address:
  • Phone: 804-464-2323
  • Fax: 804-464-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305202156
License Number StateVA

VIII. Authorized Official

Name: MR. CHRISTOPHER BRANDON REAM
Title or Position: PRESIDENT
Credential: MPT, CSCS
Phone: 804-464-2323