MEDICARE: RIVER CITY PERFORMANCE THERAPY, PLLC

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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1336720374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY PERFORMANCE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	10633 CLIFFMORE DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 HERMITAGE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-1119
Country	:	US
Telephone Number	:	252-725-1740
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HELEN SHEPARD
Credential	:	DPT
Telephone Number	:	252-725-1740

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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