Healthcare Provider Details

I. General information

NPI: 1750792404
Provider Name (Legal Business Name): NORTHERN VIRGINIA HAND THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20925 PROFESSIONAL PLAZA SUITE 300
ASHBURN VA
20147
US

IV. Provider business mailing address

20925 PROFESSIONAL PLAZA SUITE 300
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 703-544-7171
  • Fax: 703-997-4450
Mailing address:
  • Phone: 703-544-7171
  • Fax: 703-997-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119005354
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0119005354
License Number StateVA

VIII. Authorized Official

Name: DANA JILL WALLACE
Title or Position: OWNER
Credential:
Phone: 703-544-7171