Provider Demographics
NPI:1316128242
Name:DAISEY PHYSICAL THERAPY AND SPORTS
Entity type:Organization
Organization Name:DAISEY PHYSICAL THERAPY AND SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:DAISEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-854-0500
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:VA
Mailing Address - Zip Code:23303-0396
Mailing Address - Country:US
Mailing Address - Phone:757-854-0500
Mailing Address - Fax:757-854-0545
Practice Address - Street 1:7007 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:OAK HALL
Practice Address - State:VA
Practice Address - Zip Code:23416-2223
Practice Address - Country:US
Practice Address - Phone:757-854-0500
Practice Address - Fax:757-854-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204289261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy