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General NPI Number Information
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NPI Number | 1447350046
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Entity Type | Organization
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Legal Business Name | PROCARE PT PLC
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 2302 COLONIAL AVE SW STE G
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City | ROANOKE
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State | VA
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Zip | 24015-3100
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Country | US
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Telephone | 540-982-2273
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Fax | 540-982-2274
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Provider Business Mailing Address
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Address Line | 2302 COLONIAL AVE SW STE G
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City | ROANOKE
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State | VA
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Zip | 24015-3100
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Country | US
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Telephone | 540-982-2273
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Fax | 540-982-2274
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JENNIFER M RICH
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Credential |
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Telephone | 540-982-8873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1109362305005536
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License Number State | VA
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