Virginia Center for Spine & Sports Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

VIRGINIA CENTER FOR SPINE & SPORTS THERAPY LLC

Practice address

2820 Waterford Lake Dr
Suite 103
Midlothian, VA 23112-3994

Phone

(804) 249-8277

Fax

(804) 249-9690

NPI assigned

Sep 16, 2006

Last updated

Sep 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maryann Theresa Dominguez, PTNPI 1437158102

Title

Practice Administrator

Phone

(804) 249-8277

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maryann Theresa Dominguez, PT

  • Physical Therapist
  • Midlothian, VA
  • NPI 1437158102
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1598861395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 WATERFORD LAKE DR STE 103",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123994",
            "telephone_number": "804-249-8277",
            "fax_number": "804-249-9690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 WATERFORD LAKE DR",
            "address_2": "SUITE 103",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123994",
            "telephone_number": "804-249-8277",
            "fax_number": "804-249-9690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA CENTER FOR SPINE & SPORTS THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_middle_name": "THERESA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "804-249-8277",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Midlothian, VA
• Providers in Midlothian, VA by specialty
• Physical Therapy Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.