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General NPI Number Information
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NPI Number | 1710135546
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Entity Type | Organization
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Legal Business Name | SPINE & SPORT PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 640 WARRIOR DR SUITE 115
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City | STEPHENS CITY
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State | VA
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Zip | 22655-4076
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Country | US
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Telephone | 540-868-9599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1119
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City | STEPHENS CITY
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State | VA
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Zip | 22655-1119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, DIRECTOR, PHYSICAL THERAPIST
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Name | DR. KEVIN DAVID FORRER
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Credential | PT, DPT
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Telephone | 610-507-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305204141
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License Number State | VA
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