| Name | Value |
|---|---|
| PROVIDER TYPE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| CLASSIFICATION | Physical Therapist |
| AREA OF SPECIALIZATION | Hand |
| STATUS | Active |
| VA CODE | V130304 |
| X12 CODE | 2251H1200X |
| SPECIALTY CODE | 65 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255123 |
| EFFECTIVE DATE/TIME |
|