| Physiatry-sports & Family Medicine, Llc | |
|
2147 Old Greenbrier Rd Suite B Chesapeake VA 23320-2635 | |
| (757) 366-0200 | |
| Not Available |
| Full Name | Physiatry-sports & Family Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2147 Old Greenbrier Rd, Chesapeake, Virginia |
| Authorized Official Name and Position | Travis Lee (PRESIDENT) |
| Authorized Official Contact | 7573660200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physiatry-sports & Family Medicine, Llc Po Box 15763 Chesapeake VA 23328-5763 Ph: (757) 366-0200 | Physiatry-sports & Family Medicine, Llc 2147 Old Greenbrier Rd Suite B Chesapeake VA 23320-2635 Ph: (757) 366-0200 |
| NPI Number | 1770980757 |
|---|---|
| Provider Enumeration Date | 11/19/2014 |
| Last Update Date | 10/16/2015 |
| Medicare PECOS PAC ID | 1951621911 |
|---|---|
| Medicare Enrollment ID | O20150515000225 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770980757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 0101241301 (Virginia) | Primary |
| Provider Name | Travis Ray Lee |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1376732628 PECOS PAC ID: 9638257165 Enrollment ID: I20080423000497 |
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