Healthcare Provider Details

I. General information

NPI: 1578529566
Provider Name (Legal Business Name): SOAR 365
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SAUNDERS AVE
RICHMOND VA
23227-4328
US

IV. Provider business mailing address

3600 SAUNDERS AVE.
RICHMOND VA
23227-4347
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-1874
  • Fax: 804-358-7595
Mailing address:
  • Phone: 804-358-1874
  • Fax: 804-278-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SUE MITCHELL
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 804-665-1255