MEDICARE: CORE SOLUTIONS PHYSICAL THERAPY, 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	225100000X	Physical Therapist	2305005569	VA

General Provider Information

NPI Number	:	1417318064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE SOLUTIONS PHYSICAL THERAPY, LLC.

Provider Business Mailing Address
First Line	:	524 INDEPENDENCE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-2221
Country	:	US
Telephone Number	:	757-460-2522
Fax Number	:	757-460-3810

Provider Business Practice Location Address
First Line	:	524 INDEPENDENCE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-2221
Country	:	US
Telephone Number	:	757-460-2522
Fax Number	:	757-460-3810

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE PHILOPENA
Credential	:	DPT
Telephone Number	:	757-286-0544

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	03/10/2016

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