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General NPI Number Information
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NPI Number | 1356798565
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Entity Type | Organization
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Legal Business Name | CORE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 3007 WAKEFIELD DR
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City | BLACKSBURG
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State | VA
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Zip | 24060-8186
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Country | US
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Telephone | 302-383-0620
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Fax | 540-315-9868
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Provider Business Mailing Address
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Address Line | 3007 WAKEFIELD DR
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City | BLACKSBURG
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State | VA
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Zip | 24060-8186
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Country | US
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Telephone | 302-383-0620
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Fax | 540-315-9868
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | BRENDA L. MILLER
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Credential | PT
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Telephone | 302-383-0620
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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 | 2305003472
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License Number State | VA
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