MEDICARE: DOUGLAS JOHN PARK 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
1	225100000X	Physical Therapist	2305003428	VA

General Provider Information

NPI Number	:	1538205703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS JOHN PARK PT

Provider Business Mailing Address
First Line	:	2625 DOVERSHIRE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-2815
Country	:	US
Telephone Number	:	804-272-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 DOVERSHIRE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-2815
Country	:	US
Telephone Number	:	804-272-2325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	04/19/2026

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Directions to “ DOUGLAS JOHN PARK PT” Practice Location

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