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General NPI Number Information
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NPI Number | 1912027210
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Entity Type | Organization
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Legal Business Name | BLACKSTONE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 930 SOUTH MAIN ST
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City | BLACKSTONE
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State | VA
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Zip | 23824-2614
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Country | US
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Telephone | 434-292-4167
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Fax | 434-292-7554
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Provider Business Mailing Address
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Address Line | PO BOX 238
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City | BLACKSTONE
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State | VA
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Zip | 23824-0238
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Country | US
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Telephone | 434-292-4167
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Fax | 434-292-7554
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. WILLIAM H GOLD
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Credential |
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Telephone | 434-292-4167
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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 | 2305002622
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License Number State | VA
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