Healthcare Provider Details

I. General information

NPI: 1215632591
Provider Name (Legal Business Name): LIVE FIT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 PREMIER PLZ STE 110
ASHBURN VA
20147-5071
US

IV. Provider business mailing address

21791 FINDON CT
ASHBURN VA
20147-6708
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9355
  • Fax: 888-972-7952
Mailing address:
  • Phone: 703-507-8384
  • Fax: 888-972-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLESETTA MORRIS
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 703-507-8384