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General NPI Number Information
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NPI Number | 1124057211
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Entity Type | Organization
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Legal Business Name | CHURCHLAND PHYSICAL THERAPY SERVICES, INC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 5900 CHURCHLAND BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-3313
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Country | US
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Telephone | 757-483-0333
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Fax | 757-483-9359
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Provider Business Mailing Address
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Address Line | 5900 CHURCHLAND BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-3313
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Country | US
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Telephone | 757-483-0333
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Fax | 757-483-9359
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Authorized Official
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Title or Position | PRESIDENT/OWNER/PHYSICAL THERAPIST
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Name | MR. MARTIN BOYTEK JR.
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Credential | PHYSICAL THERAPIST
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Telephone | 757-483-0333
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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 | 2305000773
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License Number State | VA
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