Healthcare Provider Details

I. General information

NPI: 1497853527
Provider Name (Legal Business Name): INDEPENDENCE THERAPY CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 INDEPENDENCE CIR SUITE 3D
VIRGINIA BEACH VA
23455-6405
US

IV. Provider business mailing address

700 INDEPENDENCE CIR SUITE 3D
VIRGINIA BEACH VA
23455-6405
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-8533
  • Fax: 757-456-0616
Mailing address:
  • Phone: 757-473-8533
  • Fax: 757-456-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAS1394763
License Number StateVA

VIII. Authorized Official

Name: DR. CHARANJIT P SINGH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-473-8533