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General NPI Number Information
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NPI Number | 1871998278
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Entity Type | Organization
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Legal Business Name | DIRECT PERFORMANCE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 2247 W GREAT NECK RD STE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1556
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Country | US
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Telephone | 757-742-3778
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Fax | 757-585-3787
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Provider Business Mailing Address
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Address Line | 2247 W GREAT NECK RD STE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1556
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Country | US
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Telephone | 757-742-3778
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Fax | 757-585-3787
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Authorized Official
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Title or Position | OWNER/DPT
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Name | STEPHEN MCKENZIE
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Credential |
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Telephone | 757-748-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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