Healthcare Provider Details

I. General information

NPI: 1134751399
Provider Name (Legal Business Name): VIRGINIA SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 PREMIER PLZ STE 110
ASHBURN VA
20147-5071
US

IV. Provider business mailing address

44330 PREMIER PLZ STE 110
ASHBURN VA
20147-5071
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9355
  • Fax: 888-972-7952
Mailing address:
  • Phone: 703-723-9355
  • Fax: 888-972-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: NATHAN CRAIN
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 412-999-8380