Provider Demographics
NPI:1649723651
Name:PTL TRANSPORTATION LLC
Entity type:Organization
Organization Name:PTL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:VINES
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-665-9785
Mailing Address - Street 1:5200 CLARKTON RD
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577-3166
Mailing Address - Country:US
Mailing Address - Phone:434-665-9785
Mailing Address - Fax:434-349-3274
Practice Address - Street 1:5200 CLARKTON RD
Practice Address - Street 2:
Practice Address - City:NATHALIE
Practice Address - State:VA
Practice Address - Zip Code:24577-3166
Practice Address - Country:US
Practice Address - Phone:434-665-9785
Practice Address - Fax:434-349-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)