MEDICARE: SOUTHEASTERN PHYSICAL THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1093934861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	5301 PROVIDENCE RD
Second Line	:	SUITE 80
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4128
Country	:	US
Telephone Number	:	754-467-1900
Fax Number	:	757-467-7900

Provider Business Practice Location Address
First Line	:	905 BATTLEFIELD BLVD N
Second Line	:	SUITE 105
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4875
Country	:	US
Telephone Number	:	757-410-3157
Fax Number	:	757-410-3861

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JEFF LOWELL HARTLINE
Credential	:	MPT
Telephone Number	:	757-467-1900

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	05/22/2015

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Directions to “SOUTHEASTERN PHYSICAL THERAPY, INC ” Practice Location

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