Healthcare Provider Details

I. General information

NPI: 1942955729
Provider Name (Legal Business Name): SPORTS THERAPY AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 16TH ST NW STE 200
WASHINGTON DC
20036-4818
US

IV. Provider business mailing address

1112 16TH ST NW STE 200
WASHINGTON DC
20036-4818
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-1737
  • Fax: 202-223-1738
Mailing address:
  • Phone: 202-223-1737
  • Fax: 202-223-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LUCIA LEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-369-5668