=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982475885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | P4 PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2024
-----------------------------------------------------
Last Update Date | 01/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12349 MARTINSVILLE HWY
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-0855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-732-1575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12349 MARTINSVILLE HWY
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-0855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-732-1575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT
-----------------------------------------------------
Name | TIFFANY D BAILEY
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 276-732-1575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------