Healthcare Provider Details

I. General information

NPI: 1821262643
Provider Name (Legal Business Name): CHARLOTTESVILLE LEAGUE OF THERAPISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 3RD ST SW
ROANOKE VA
24016-5205
US

IV. Provider business mailing address

1420 3RD ST SW
ROANOKE VA
24016-5205
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-3577
  • Fax: 540-343-3866
Mailing address:
  • Phone: 540-343-3577
  • Fax: 540-343-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number41105001
License Number StateVA

VIII. Authorized Official

Name: VICTORIA GIBSON
Title or Position: HR ASSISTANT
Credential:
Phone: 434-984-0023