Healthcare Provider Details

I. General information

NPI: 1487204376
Provider Name (Legal Business Name): COLIN G GELDART DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22505 LANDMARK CT STE 215
ASHBURN VA
20148-6502
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-1616
  • Fax: 703-726-1613
Mailing address:
  • Phone: 571-423-5750
  • Fax: 571-423-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213173
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: