Healthcare Provider Details

I. General information

NPI: 1023739554
Provider Name (Legal Business Name): SCOTT ELLSWORTH RHODES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20041 RIVERSIDE COMMONS PLAZA
ASHBURN VA
20147
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 703-277-2663
  • Fax: 703-810-5323
Mailing address:
  • Phone: 804-915-1910
  • Fax: 804-327-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215386
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: