MEDICARE: SNF PHYSIATRY SERVICES VA LLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1255168894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNF PHYSIATRY SERVICES VA LLC

Provider Business Mailing Address
First Line	:	185 ROUTE 70 STE 305
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-0911
Country	:	US
Telephone Number	:	732-813-0799
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 DANIEL SMITH RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1104
Country	:	US
Telephone Number	:	877-544-4446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES COLE
Credential	:
Telephone Number	:	877-544-4446

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	03/02/2026

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