Healthcare Provider Details

I. General information

NPI: 1902875388
Provider Name (Legal Business Name): CHRISTINE CATHARINE ACCETTELLA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax: 757-361-3957
Mailing address:
  • Phone: 757-361-3954
  • Fax: 757-361-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006706
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0126000619
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: