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General NPI Number Information
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NPI Number | 1225709306
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Entity Type | Organization
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Legal Business Name | FORMATION PT & PERFORMANCE PLLC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 8 S CRENSHAW AVE
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City | RICHMOND
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State | VA
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Zip | 23221-2732
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Country | US
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Telephone | 804-442-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 8 S CRENSHAW AVE
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City | RICHMOND
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State | VA
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Zip | 23221-2732
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Country | US
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Telephone | 804-442-6212
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Fax | 804-508-6947
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Authorized Official
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Title or Position | FOUNDER, PHYSICAL THERAPIST
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Name | DR. ALLISON BEALE
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Credential | PT, DPT
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Telephone | 804-442-6212
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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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