King William Physical Therapy
Organization Active NPI Comprehensive Outpatient Rehabilitation Facility (CORF) · Aylett, VA
NPI 1508049255 · NPPES record last updated Feb 22, 2023
Key facts
- NPI
- 1508049255
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X
- License
- S094294-8 (VA)
- Legal business name
- KING WILLIAM PHYSICAL THERAPY
- Practice address
- 5983 Richmond Tappahannock Hwy
Aylett, VA 23009-3009 - Phone
- (804) 769-7504
- Fax
- (804) 769-7524
- NPI assigned
- Dec 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Timothy Wayne McDaniel, P.T.
- Title
- Owner
- Phone
- (804) 769-7504
Practitioners 6
-
Timothy Wayne McDaniel, P.T.
-
Phyllis Grimmer Eberline, PT,DPT
-
Jenny Place, DPT
-
Martha Lelia McDaniel, OTR/L
-
Colton Leland McGhee, ATC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120511000280 | VA | Part B Supplier - Clinic/Group Practice | 8820251739 |
Receives reassigned benefits from 3 practitioners Practice locations: Aylett, VA |
National Provider Directory
Locations
694 Sharon Rd
Ste R
King William, VA 23086
Phone (804) 769-7504
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | S094294-8 | VA | Yes |
Addresses
Primary practice location
5983 Richmond Tappahannock Hwy
Aylett, VA 23009-3009
Mailing address
5983 Richmond Tappahannock Hwy
Aylett, VA 23009-3009
Phone (804) 769-7504
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010029686 | Medicaid | VA |
Other providers in Aylett, VA
- Lauren Jenkins
- Aleyah Chanel Kelly
- Geri Nicole Kennedy
- King William County Board of Supervisors
- King William Pharmacy Inc
- King William Volunteer Fire and Rescue
- Augustine Warner Lewis III
- Grace Limbaugh
- Anna A Limberger
- Sara Eleanor Hooper Majewski
All providers in Aylett, VA · Comprehensive Outpatient Rehabilitation Facility (CORF) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.