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General NPI Number Information
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NPI Number | 1922501485
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Entity Type | Organization
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Legal Business Name | VIRGINIA OUTPATIENT AT HOME LLC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 1046 RIVERMONT TER
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City | LYNCHBURG
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State | VA
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Zip | 24503-2546
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Country | US
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Telephone | 540-871-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 1046 RIVERMONT TER
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City | LYNCHBURG
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State | VA
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Zip | 24503-2546
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Country | US
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Telephone | 540-871-3426
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN A COFFEY
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Credential | DPT
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Telephone | 540-871-3426
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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 | 2305209634
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License Number State | VA
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