Healthcare Provider Details

I. General information

NPI: 1548260193
Provider Name (Legal Business Name): PROACTIVE THERAPY OF VIRGINIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 ELECTRIC RD SUITE 101
ROANOKE VA
24018-3528
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DEPARTMENT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 540-989-8974
  • Fax: 540-989-4695
Mailing address:
  • Phone: 717-972-1100
  • Fax: 711-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. MICHAEL E. TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100