Organization
ORTHOVIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PROFFITT (CREDENTIALING & ENROLLMENT)
(804) 533-2357
Entity
Organization
Contact information
Practice address
250 S MAIN ST, SUITE 224A, BLACKSBURG, VA 24060
(540) 552-7133
(540) 342-2193
Mailing address
PO BOX 715868, PHILADELPHIA, PA 19171-4067
(804) 915-1910
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0102204066
VA
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
Other
Enumeration date
06/08/2016
Last updated
08/17/2023
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