Healthcare Provider Details

I. General information

NPI: 1255773040
Provider Name (Legal Business Name): THERAPY UNLIMITED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 WILMER AVE
RICHMOND VA
23227-2653
US

IV. Provider business mailing address

309 WILMER AVENUE
RICHMOND VA
23227
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-1758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number2202006255
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number2202005827
License Number StateVA

VIII. Authorized Official

Name: MS. RENETTA MARCELLINA ST. JULIAN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 804-562-1758