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General NPI Number Information
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NPI Number | 1245617000
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Entity Type | Organization
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Legal Business Name | RIDGELINE PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 2901 SELMA-LOW MOOR RD
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City | LOW MOOR
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State | VA
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Zip | 24457
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Country | US
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Telephone | 757-647-9177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | LOW MOOR
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State | VA
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Zip | 24457-0215
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Country | US
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Telephone | 757-647-9177
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JONATHAN EATON
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Credential | PT
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Telephone | 757-647-9177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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