Healthcare Provider Details

I. General information

NPI: 1265598668
Provider Name (Legal Business Name): BEYOND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 PREMIER PLZ SUITE 110
ASHBURN VA
20147-5025
US

IV. Provider business mailing address

44330 PREMIER PLZ SUITE 110A
ASHBURN VA
20147-5025
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556378
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305001360
License Number StateVA

VIII. Authorized Official

Name: DR. EUGENE MING SU
Title or Position: CEO
Credential: DC, MAOM
Phone: 703-975-3278