Healthcare Provider Details

I. General information

NPI: 1679946834
Provider Name (Legal Business Name): PHYSIOTHERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number0119006782
License Number StateVA

VIII. Authorized Official

Name: CHRISTINE ACCETTELLA
Title or Position: CLINIC DIRECTOR
Credential: PT
Phone: 757-361-3954