MEDICARE: NANCY J PLACIDE PT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305004333	VA

General Provider Information

NPI Number	:	1114108818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY J PLACIDE PT

Provider Business Mailing Address
First Line	:	2820 WATERFORD LAKE DR STE 103
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-3994
Country	:	US
Telephone Number	:	804-249-8277
Fax Number	:	804-249-9690

Provider Business Practice Location Address
First Line	:	2820 WATERFORD LAKE DR STE 103
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-3994
Country	:	US
Telephone Number	:	804-249-8277
Fax Number	:	804-249-9690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	08/26/2022

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