Healthcare Provider Details

I. General information

NPI: 1104023001
Provider Name (Legal Business Name): EDUARDO ANTONIO URRUTIA LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 S HAYES ST
ARLINGTON VA
22202-2714
US

IV. Provider business mailing address

1946 STORM DR
FALLS CHURCH VA
22043-1412
US

V. Phone/Fax

Practice location:
  • Phone: 703-920-5700
  • Fax:
Mailing address:
  • Phone: 703-893-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306601945
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: