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NPI Code Detail

MEDICARE: MS. THERESA M MCCULLOUGH PT

MEDICARE: MS. THERESA M MCCULLOUGH 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
1261QP2000XPhysical Therapy Clinic/Center2305203454VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1209238OTHERVASOUTHERN HEALTH
27493361OTHERVAAETNA

General Provider Information

NPI Number : 1457477838
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THERESA M MCCULLOUGH PT
Provider Business Mailing Address
First Line : 1725 VERONA DR
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22911-3545
Country : US
Telephone Number : 434-466-3317
Fax Number : 434-979-8536
Provider Business Practice Location Address
First Line : 3040 BERKMAR DR STE A1
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22901-1593
Country : US
Telephone Number : 434-979-8628
Fax Number : 434-979-8536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 01/05/2026

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