Provider Demographics
NPI:1679848824
Name:DUVAL INTEGRATIVE PHYSICAL THERAPY
Entity type:Organization
Organization Name:DUVAL INTEGRATIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:804-789-1180
Mailing Address - Street 1:9245 SHADY GROVE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2890
Mailing Address - Country:US
Mailing Address - Phone:804-789-1180
Mailing Address - Fax:804-780-1181
Practice Address - Street 1:9245 SHADY GROVE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2890
Practice Address - Country:US
Practice Address - Phone:804-789-1180
Practice Address - Fax:804-780-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty