Provider Demographics
NPI:1609816495
Name:PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:276-236-8974
Mailing Address - Street 1:211 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2846
Mailing Address - Country:US
Mailing Address - Phone:276-236-8974
Mailing Address - Fax:276-236-4735
Practice Address - Street 1:211 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2846
Practice Address - Country:US
Practice Address - Phone:276-236-8974
Practice Address - Fax:276-236-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001213261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA238546OtherANTHEM