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General NPI Number Information
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NPI Number | 1700837838
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Entity Type | Organization
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Legal Business Name | WATAUGA PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16487 JEB STUART HWY
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City | ABINGDON
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State | VA
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Zip | 24211-7449
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Country | US
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Telephone | 276-628-8113
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Fax | 276-628-8032
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Provider Business Mailing Address
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Address Line | PO BOX 1823
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City | ABINGDON
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State | VA
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Zip | 24212-1823
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Country | US
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Telephone | 276-628-8113
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Fax | 276-628-8032
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JANE W BOYLES
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Credential | P.T.
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Telephone | 276-628-8113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | NO STATE LICENSE
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License Number State | VA
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