MEDICARE: ORTHOVIRGINIA, INC

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
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1770620791
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	:	19171-5868
Country	:	US
Telephone Number	:	804-915-1910
Fax Number	:	804-560-9029

Provider Business Practice Location Address
First Line	:	13801 ST FRANCIS BLVD
Second Line	:	STE 200
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-3206
Country	:	US
Telephone Number	:	804-270-1305
Fax Number	:	804-273-9294

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	06/06/2022

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Directions to “ORTHOVIRGINIA, INC ” Practice Location

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