Provider Demographics
NPI:1316081607
Name:ABERCROMBIE, RICHARD LEA (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEA
Last Name:ABERCROMBIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4117
Mailing Address - Country:US
Mailing Address - Phone:434-799-6100
Mailing Address - Fax:434-799-1116
Practice Address - Street 1:2811 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4117
Practice Address - Country:US
Practice Address - Phone:434-799-6100
Practice Address - Fax:434-799-1116
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V163A82Medicare ID - Type Unspecified