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General NPI Number Information
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NPI Number | 1063128486
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1506 PRITCHARD TER
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-6295
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Country | US
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Telephone | 804-314-1856
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Fax |
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Provider Business Mailing Address
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Address Line | 7501 LADY BLAIR LN #74367
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City | RICHMOND
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State | VA
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Zip | 23236
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Country | US
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Telephone | 804-314-1856
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | ANDREW WILLIE OLIVER
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Credential | PT, DPT
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Telephone | 804-314-1856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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