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Organization
PERFORMANCE PHYSICAL THERAPY OF STAFFORD, LLC
Active
Organization
PERFORMANCE PHYSICAL THERAPY OF STAFFORD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATASHA R BLANTON DPT (OWNER)
(540) 327-1740
Entity
Organization
Contact information
Practice address
2777 JEFFERSON DAVIS HWY, 109, STAFFORD, VA 22554-8323
(540) 318-8615
(540) 318-8619
Mailing address
2777 JEFFERSON DAVIS HWY, SUITE 109, STAFFORD, VA 22554-6219
(540) 318-8615
(540) 318-8619
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305204166
VA
2251G0304X
Geriatric Physical Therapist
2305204166
VA
2251P0200X
Pediatric Physical Therapist
2305204166
VA
2251S0007X
Sports Physical Therapist
2305204166
VA
2251X0800X
Orthopedic Physical Therapist
2305204166
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAA101671
MEDICARE PTAN
VA
Enumeration date
08/03/2010
Last updated
09/17/2014
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