Healthcare Provider Details

I. General information

NPI: 1649723651
Provider Name (Legal Business Name): PTL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CLARKTON RD
NATHALIE VA
24577-3166
US

IV. Provider business mailing address

5200 CLARKTON RD
NATHALIE VA
24577-3166
US

V. Phone/Fax

Practice location:
  • Phone: 434-665-9785
  • Fax: 434-349-3274
Mailing address:
  • Phone: 434-665-9785
  • Fax: 434-349-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA VINES GARRETT
Title or Position: OWNER/MEMBER
Credential:
Phone: 434-665-9785