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General NPI Number Information
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NPI Number | 1700503992
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Entity Type | Organization
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Legal Business Name | CTL OF VA LLC
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 210 PROFESSIONAL PARK DR SE STE 9
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City | BLACKSBURG
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State | VA
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Zip | 24060-6649
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Country | US
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Telephone | 904-616-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 210 PROFESSIONAL PARK DR SE STE 9
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City | BLACKSBURG
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State | VA
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Zip | 24060-6649
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Country | US
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Telephone | 904-616-3040
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ROBERT KENNY
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Credential |
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Telephone | 904-576-0786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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