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General NPI Number Information
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NPI Number | 1679848824
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Entity Type | Organization
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Legal Business Name | DUVAL INTEGRATIVE PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 9245 SHADY GROVE RD SUITE 201
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2890
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Country | US
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Telephone | 804-789-1180
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Fax | 804-780-1181
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Provider Business Mailing Address
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Address Line | 9245 SHADY GROVE RD SUITE 201
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2890
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Country | US
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Telephone | 804-789-1180
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Fax | 804-780-1181
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN C DUVAL
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Credential | MPT
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Telephone | 804-789-1180
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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 | 2305004572
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License Number State | VA
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