Provider Demographics
NPI:1548254634
Name:SENIOR JOURNEYS LLC
Entity type:Organization
Organization Name:SENIOR JOURNEYS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:FUJIE
Authorized Official - Last Name:SCHRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:434-361-2650
Mailing Address - Street 1:804 AFTON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:VA
Mailing Address - Zip Code:22920-2408
Mailing Address - Country:US
Mailing Address - Phone:434-361-2650
Mailing Address - Fax:434-361-2511
Practice Address - Street 1:1543 BEECH GROVE RD
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:VA
Practice Address - Zip Code:22967-2211
Practice Address - Country:US
Practice Address - Phone:434-361-2650
Practice Address - Fax:434-361-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08394Medicare ID - Type UnspecifiedGROUP
DD0247Medicare ID - Type UnspecifiedGROUP