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General NPI Number Information
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NPI Number | 1699175810
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Entity Type | Organization
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Legal Business Name | BOTETOURT PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 104 KINGSTON DR
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City | DALEVILLE
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State | VA
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Zip | 24083-2575
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Country | US
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Telephone | 540-992-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 104 KINGSTON DR
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City | DALEVILLE
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State | VA
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Zip | 24083-2575
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Country | US
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Telephone | 540-992-3660
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ERIC WILLIAM THORNE
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Credential | PT
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Telephone | 540-992-3660
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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 | 2305207120
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License Number State | VA
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