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Organization
SOUTHSIDE THERAPY ASSOCIATES, INC.
Active
Organization
SOUTHSIDE THERAPY ASSOCIATES, INC.
Active
Other names
Progressive Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
KIM HUDGINS (DIRECTOR OF BUSINESS AFFAIRS)
(434) 392-4910
Entity
Organization
Contact information
Practice address
1412 W 3RD ST, FARMVILLE, VA 23901-2648
(434) 392-1596
(434) 392-5201
Mailing address
PO BOX 468, FARMVILLE, VA 23901-0468
(434) 392-4910
(434) 392-8793
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004978889
—
VA
Enumeration date
08/26/2005
Last updated
01/24/2012
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