MEDICARE: ORTHOVIRGINIA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	261QM1300X	Multi-Specialty Clinic/Center
4	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)
5	363A00000X	Physician Assistant
6	363L00000X	Nurse Practitioner
7	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1518584796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOVIRGINIA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 715868
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19171-4067
Country	:	US
Telephone Number	:	804-915-1910
Fax Number	:	804-560-9029

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVENUE
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-6818
Country	:	US
Telephone Number	:	703-810-5208
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING & ENROLLMENT
Name	:	NICOLE PROFFITT
Credential	:
Telephone Number	:	804-533-2357

Provider Enumeration Date	:	07/03/2020
Last Update Date	:	08/17/2023

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Directions to “ORTHOVIRGINIA, INC. ” Practice Location

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