Healthcare Provider Details

I. General information

NPI: 1841933595
Provider Name (Legal Business Name): CARDINAL PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21750 RED RUM DR STE 117
ASHBURN VA
20147-5867
US

IV. Provider business mailing address

21750 RED RUM DR STE 117
ASHBURN VA
20147-5867
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-2989
  • Fax:
Mailing address:
  • Phone: 703-574-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY HEMINGWAY
Title or Position: OWNER
Credential: OTR/L
Phone: 703-505-7605