Provider Demographics
NPI:1548555659
Name:AMBER PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:AMBER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:732-895-8668
Mailing Address - Street 1:9269 OLD KEENE MILL RD STE A
Mailing Address - Street 2:ROLLING VALLEY CENTER
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4202
Mailing Address - Country:US
Mailing Address - Phone:732-895-8668
Mailing Address - Fax:571-358-8800
Practice Address - Street 1:9269 OLD KEENE MILL RD STE A
Practice Address - Street 2:ROLLING VALLEY CENTER
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4202
Practice Address - Country:US
Practice Address - Phone:732-895-8668
Practice Address - Fax:571-358-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202069261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy