Healthcare Provider Details

I. General information

NPI: 1629670765
Provider Name (Legal Business Name): FUSION PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 THE HAGUE PL
DULLES VA
20189-5769
US

IV. Provider business mailing address

UNIT 5770 BOX 115
DPO AE
09715-0115
US

V. Phone/Fax

Practice location:
  • Phone: 727-230-9655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE BOBBITT
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 727-230-9655