# OLD DOMINION PHYSICAL MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508250697
- **Authorized official:** TODD A WICHMAN M.D. (OWNER)
- **Authorized official phone:** (804) 521-5310

## Contact information

- **Practice address:** 5700 FITZHUGH AVE, HEALTHSOUTH REHABILITATION HOSPITAL, RICHMOND, VA 23226-1800
- **Practice address phone:** (804) 521-5310
- **Mailing address:** 3900 WESTERRE PKWY, SUITE 300, RICHMOND, VA 23233-1478
- **Mailing address phone:** (804) 521-5310
- **Mailing address fax:** (804) 477-1252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 0101253471 | VA | Yes |

## Other

- **Enumeration date:** 03/26/2015
- **Last updated:** 03/26/2015