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General NPI Number Information
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NPI Number | 1891922928
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Entity Type | Organization
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Legal Business Name | PRIS,PLC
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 2600 MEMORIAL AVE SUITE 201B
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City | LYNCHBURG
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State | VA
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Zip | 24501-2662
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Country | US
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Telephone | 434-528-0896
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Fax | 434-528-0898
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Provider Business Mailing Address
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Address Line | 2600 MEMORIAL AVE SUITE 201B
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City | LYNCHBURG
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State | VA
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Zip | 24501-2662
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Country | US
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Telephone | 434-528-0896
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Fax | 434-528-0898
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Authorized Official
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Title or Position | CEO
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Name | DR. BRENDA SUE WALLER
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Credential | MD
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Telephone | 434-528-0896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 0101055485
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101055485
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License Number State | VA
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