Organization
FULL STRIDE PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JC KOEHN (OWNER)
(434) 532-6020
Entity
Organization
Contact information
Practice address
1223 VILLA LN UNIT F, CHARLOTTESVILLE, VA 22903-6569
(434) 532-6020
Mailing address
513 EAST MAIN STREET, P.O. BOX 1695, CHARLOTTESVILLE, VA 22902
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/23/2017
Last updated
10/23/2017
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