Organization Name: | DOMINION PHYSICAL THERAPY |
NPI Number: | 1265810451 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAURA BARRETT (OWNER) |
Mailing Address: | 12713 Camden Park Ct Bristow |
State: | VA US |
Postal Code: | 201361291 |
Phone Number: | 7038991732 |
Fax Number: | |
NPI Enumeration Date: | 05/08/2015 |
NPI Last Update Date: | 05/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |