OLD DOMINION UNIVERSITY (NPI# 1871929729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871929729 |
| Entity Type | Organization |
| Organization Name | OLD DOMINION UNIVERSITY |
| Other Organization Name | ODU MONARCH PHYSICAL THERAPY |
| Practice Address |
1015 W 47th St Norfolk VA 23529-0001 |
| Practice Telephone | 7576837041 |
| Practice Fax Number | 7576837050 |
| Mailing Telephone | 7576837041 |
| Mailing Fax Number | 7576837138 |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2014-08-14 |
| Authorized Official Name | LISA R KOPERNA (CLINIC DIRECTOR) |
| Authorized Official Telephone | 7576834228 |
| Authorized Official Credential | DPT |
| Is Organization Subpart | Y |
| Parent Organization Name | OLD DOMINION UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| ODU Monarch Physical Therapy | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | OLD DOMINION UNIVERSITY | Old Dominion University, 200 Koch Hall, Norfolk, VA 23529 |
| Virginia Business Entities | OLD DOMINION UNIVERSITY CREDIT UNION INC. | 2701 Hampton Blvd, Norfolk, Virginia 23517 |
| Virginia Business Entities | OLD DOMINION UNIVERSITY EDUCATIONAL FOUNDATION | 4417 Monarch Way Fl 4, Norfolk, Virginia 23508-2548 |
| Virginia Business Entities | OLD DOMINION UNIVERSITY RESEARCH FOUNDATION | P O Box 6369, Norfolk, Virginia 23508 |
| Street Address |
1015 W 47TH ST |
| City | NORFOLK |
| State | VA |
| Zip Code | 23529-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720057110 | Lisa Renee Koperna | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2006-03-16 |
| 1104439371 | Lauren Rice | Occupational Therapist | 1015 W 47th St, Norfolk, VA 23508 | 2020-08-27 |
| 1518590793 | Shea Dineen | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2020-02-17 |
| 1346807112 | Sharese Joell Douglas | Physical Therapy Assistant | 1015 W 47th St, Norfolk, VA 23508 | 2019-05-28 |
| 1023596681 | Ryan Christopher Hunt | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2018-08-04 |
| 1962993527 | Tricia Morgan L'heureux | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2018-05-18 |
| 1124561147 | Rebecca Sargeant | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2016-11-22 |
| 1629439013 | Mary Grace Rafanan | Occupational Therapy Assistant | 1015 W 47th St, Norfolk, VA 23529-0001 | 2016-03-11 |
| 1821461682 | Leslie Prom | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2015-11-02 |
| 1558761015 | Samantha Ficksman | Physical Therapist | 1015 W 47th St, Norfolk, VA 23529-0001 | 2014-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528681939 | Breanna Jo Davis | Student in an Organized Health Care Education/Training Program | 5115 Hampton Boulevard, Norfolk, VA 23529-0001 | 2020-05-20 |
| 1912564311 | Briana M Lawry | Specialist/Technologist | 4608 Hampton Blvd, Norfolk, VA 23529-0001 | 2019-05-22 |
| 1679054035 | Charles Marshall Mozena | Specialist/Technologist | 4700 Powhatan Avenue, Norfolk, VA 23529-0001 | 2018-08-23 |
| 1669960258 | Dana Slepsky Robertson | Speech-Language Pathologist | 1015 W 47th Street, Norfolk, VA 23529-0001 | 2018-04-29 |
| 1326548140 | Trevor Thompson | Specialist/Technologist | Old Dominion University 5115 Hampton Blvd, Norfolk, VA 23529-0001 | 2018-02-19 |
| 1104335629 | Michael Andrew Burkeitt | Specialist/Technologist | 4500 Parker Avenue, Norfolk, VA 23529-0001 | 2017-09-27 |
| 1437682705 | Robert Medina | Specialist/Technologist | 4500 Parker Ave, Norfolk, VA 23529-0001 | 2017-04-04 |
| 1053767426 | Michael Olson | Specialist/Technologist | Jim Jarrett Athletic Admin Building, Norfolk, VA 23529-0001 | 2016-05-04 |
| 1144639568 | Heather Mckay Byrne | Physical Therapist | Odu Monarch Physical Therapy, 1015 West 47th Street, Norfolk, VA 23529-0001 | 2014-08-11 |
| 1770991051 | Cori Winifred Sinnott | Specialist/Technologist | 5115 Hampton Blvd, Norfolk, VA 23529-0001 | 2014-07-30 |
| Find all providers in zip 23529 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013527381 | Movement Is Medicine Physical Therapy and Sports Performance | Clinic/Center | 508 Connecticut Ave, Norfolk, VA 23508-2706 | 2020-08-03 |
| 1326475781 | Norfolk Physcial Therapy | Clinic/Center | 1220 Benjamin Ave, Norfolk, NE 68701-2769 | 2013-10-01 |
| 1841214426 | Heartland Physical Therapy, Inc. | Clinic/Center | 2612 W Norfolk Ave, Norfolk, NE 68701-4423 | 2006-07-27 |
| 1144838780 | Inspired Physical Therapy | Clinic/Center | 870 N Military Hwy, Suite 224, Norfolk, VA 23502-3638 | 2020-07-20 |
| 1932615150 | Dppt 2, LLC | Clinic/Center | 1900 Monticello Ave, Norfolk, VA 23517-2339 | 2017-12-26 |
| 1063784346 | Norfolk Physical Therapy PC | Clinic/Center | 1220 W Benjamin Ave, Suite 4, Norfolk, NE 68701-2769 | 2012-02-02 |
| 1457664765 | Norfolk Physical Therapy, PC | Clinic/Center | 1220 W Benjamin Ave, Suite 4, Norfolk, NE 68701-2769 | 2010-07-16 |
| 1356661078 | Ryan John Wolken | Clinic/Center | 2108 Taylor Ave, Ste 1100, Norfolk, NE 68701-4642 | 2010-06-04 |
| 1912171604 | Gait Center Hampton Roads | Clinic/Center | 6325 N Center Dr, Building 18, Suite 100, Norfolk, VA 23502-4010 | 2008-04-15 |
| 1750461299 | Physiotherapy Associates Inc | Clinic/Center | 6315 N Center Dr, Bldg 20, Ste 250, 2nd Floor, Norfolk, VA 23502-4006 | 2006-10-17 |
| Find all providers in NORFOLK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.