Organization
SOUTH RIVER REHABILITATION AND PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN THOMAS DIMITT (OWNER, PHYSICAL THERAPIST)
(540) 490-0308
Entity
Organization
Contact information
Practice address
38 EBCO CIR, WAYNESBORO, VA 22980-7344
(540) 490-0308
(540) 451-7064
Mailing address
38 EBCO CIR STE 106, WAYNESBORO, VA 22980-7344
(540) 490-0308
(540) 451-7064
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407142482
NPI
VA
Enumeration date
05/29/2019
Last updated
05/25/2021
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