Healthcare Provider Details

I. General information

NPI: 1780323188
Provider Name (Legal Business Name): JOHNATHAN OXFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HEALTH CARE DR
PENNINGTON GAP VA
24277-2854
US

IV. Provider business mailing address

281 MOUNTAIN ASH DRIVE
DRYDEN VA
24243
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-2566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604344
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: