Healthcare Provider Details

I. General information

NPI: 1225273626
Provider Name (Legal Business Name): ONSITE PHYSICAL THERAPY AND CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2008
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 RIVER EDGE RD
NORFOLK VA
23502-3509
US

IV. Provider business mailing address

5308 RIVER EDGE RD
NORFOLK VA
23502-3509
US

V. Phone/Fax

Practice location:
  • Phone: 757-971-3464
  • Fax: 757-423-8298
Mailing address:
  • Phone: 757-971-3464
  • Fax: 757-423-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202617
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN LERON EDMONDS
Title or Position: PRESIDENT
Credential: MPT
Phone: 757-971-3464