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General NPI Number Information
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NPI Number | 1790326643
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Entity Type | Organization
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Legal Business Name | PETE'S TRANSPORT
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 625 PINEY FOREST RD STE 401B
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City | DANVILLE
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State | VA
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Zip | 24540-2870
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Country | US
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Telephone | 434-334-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 625 PINEY FOREST RD STE 401B
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City | DANVILLE
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State | VA
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Zip | 24540-2870
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Country | US
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Telephone | 434-334-7383
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | TYNESHA NICOLE BREEDLOVE
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Credential |
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Telephone | 434-251-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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