Provider Demographics
NPI:1124890587
Name:PHYSICAL THERAPY SPECIALISTS OF VIRGINIA LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:804-304-8214
Mailing Address - Street 1:9600 GADWELL TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5290
Mailing Address - Country:US
Mailing Address - Phone:804-304-8214
Mailing Address - Fax:
Practice Address - Street 1:720 MOOREFIELD PARK DR STE 303
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3657
Practice Address - Country:US
Practice Address - Phone:804-304-8214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty