Organization
AMELIA WELLNESS AND REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYLER M MOORE (OWNER)
(804) 561-1617
Entity
Organization
Contact information
Practice address
12882 PATRICK HENRY HWY, AMELIA, VA 23002-3929
(804) 561-1617
(804) 561-5533
Mailing address
12882 PATRICK HENRY HWY, AMELIA, VA 23002-3929
(804) 561-1617
(804) 561-5533
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305006053
VA
225X00000X
Occupational Therapist
0119002329
VA
235Z00000X
Speech-Language Pathologist
2202004731
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194219
ANTHEM PT
VA
01
—
194220
ANTHEM-OT
VA
01
—
194221
ANTHEM-ST
VA
01
—
431649
SOUTHERN HEALTH
VA
Enumeration date
05/08/2006
Last updated
01/09/2008
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