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Organization
SPORTS ENHANCEMENT PHYSICAL THERAPY
Active
Organization
SPORTS ENHANCEMENT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY-KAY AUDRA WYNN PT (OWNER)
(540) 308-3358
Entity
Organization
Contact information
Practice address
2607 LAKEVIEW PKWY, LOCUST GROVE, VA 22508-5726
(540) 308-3357
Mailing address
2607 LAKEVIEW PKWY, LOCUST GROVE, VA 22508-5726
(540) 308-3358
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
06/04/2020
Last updated
06/04/2020
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