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General NPI Number Information
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NPI Number | 1750037610
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 762 INDEPENDENCE BLVD STE B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6200
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Country | US
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Telephone | 757-497-7575
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Fax | 757-490-1795
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Provider Business Mailing Address
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Address Line | 762 INDEPENDENCE BLVD STE B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6200
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Country | US
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Telephone | 757-497-7575
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Fax | 757-490-1795
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS GLADDYS O PASCO
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Credential |
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Telephone | 757-497-7575
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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 |
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License Number State |
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