Basic Information
| Provider Information | |||||||||
| NPI: | 1447240965 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMHERST PHYSICAL THERAPY LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 720 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245210720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349461314 | ||||||||
| FaxNumber: | 4349461083 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245212616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349461314 | ||||||||
| FaxNumber: | 4349461083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TORODE | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | MAURICE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4349461314 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 318235 | 01 | VA | BLUE CROSS BLUE SHIELD | OTHER | 217635 | 01 | VA | BLUE CROSS BLUE SHIELD | OTHER | 210448 | 01 | VA | SOUTHERN HEALTH | OTHER |