MEDICARE: MVPT, 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	261QP2000X	Physical Therapy Clinic/Center	2305202156	VA

General Provider Information

NPI Number	:	1417260209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVPT, LLC

Provider Business Mailing Address
First Line	:	14265 MIDLOTHIAN TPKE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-6560
Country	:	US
Telephone Number	:	804-464-2323
Fax Number	:	804-464-2323

Provider Business Practice Location Address
First Line	:	14265 MIDLOTHIAN TPKE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-6560
Country	:	US
Telephone Number	:	804-464-2323
Fax Number	:	804-464-2323

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHRISTOPHER BRANDON REAM
Credential	:	MPT, CSCS
Telephone Number	:	804-464-2323

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	07/21/2010

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