Organization
VIRGINIA CENTER FOR SPINE & SPORTS THERAPY LLC
Active
Organization
VIRGINIA CENTER FOR SPINE & SPORTS THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYANN THERESA DOMINGUEZ PT (PRACTICE ADMINISTRATOR)
(804) 249-8277
Entity
Organization
Contact information
Practice address
2820 WATERFORD LAKE DR, SUITE 103, MIDLOTHIAN, VA 23112-3994
(804) 249-8277
(804) 249-9690
Mailing address
2820 WATERFORD LAKE DR STE 103, MIDLOTHIAN, VA 23112-3994
(804) 249-8277
(804) 249-9690
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
09/16/2006
Last updated
09/22/2021
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