Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Sep 27, 2018
License(s)
24070 (MA), J1-0003979 (DE), 2305213774 (VA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 680 KINGSBOROUGH SQ STE B | Chesapeake, VA 23320-4988 | 757-547-0434 |
| MAILING | 350 NEW FIDELITY CT | Garner, NC 27529-2665 | 919-258-2714 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.