Physiatry-Sports & Family Medicine, LLC
Clinic/Center, Multi-Specialty in Chesapeake, VA. Organization (NPI-2).
NPI number1770980757
StatusActive
Last updated in NPPESOct 16, 2015
Details
- NPI
- 1770980757
- Entity type
- Organization (NPI-2)
- Legal business name
- Physiatry-Sports & Family Medicine, LLC
- Organization subpart
- No
- Enumeration date
- Nov 19, 2014
- Last updated
- Oct 16, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | 0101241301 | VA | Yes |
Practice location
2147 Old Greenbrier RdSuite B
Chesapeake, VA 23320-2635
Phone 757-366-0200
Mailing address
Po Box 15763Chesapeake, VA 23328-5763
Phone 757-366-0200
Authorized official
Travis Lee
President
7573660200
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