Healthcare Provider Details

I. General information

NPI: 1215697511
Provider Name (Legal Business Name): BRENNA SHEA SCOTT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 GROVEDALE DRIVE SUITE 102
ALEXANDRIA VA
22310-2596
US

IV. Provider business mailing address

224D CORNWALL STREET NW SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-884-8490
  • Fax: 703-313-0178
Mailing address:
  • Phone: 703-737-6001
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT030059
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214816
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: