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General NPI Number Information
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NPI Number | 1083623284
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL THERAPY OF VIRGINIA INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1620 APPERSON DR
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City | SALEM
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State | VA
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Zip | 24153-7217
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Country | US
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Telephone | 540-444-0291
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Fax | 540-444-0293
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Provider Business Mailing Address
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Address Line | 1620 APPERSON DR
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City | SALEM
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State | VA
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Zip | 24153-7217
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Country | US
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Telephone | 540-444-0291
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Fax | 540-444-0293
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS LEE ELLEXSON
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Credential | PT
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Telephone | 540-444-0291
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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 | 230500588
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License Number State | VA
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