Organization
FORM AND FUNCTION PHYSICAL THERAPY PLLC
Active
Organization
FORM AND FUNCTION PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRATIK C SHAH DPT (CEO)
(804) 564-5194
Entity
Organization
Contact information
Practice address
11411 HUNTON COTTAGE CT, GLEN ALLEN, VA 23059-4848
(804) 564-5194
Mailing address
11411 HUNTON COTTAGE CT, GLEN ALLEN, VA 23059-4848
(804) 564-5194
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/28/2023
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