Healthcare Provider Details

I. General information

NPI: 1750377990
Provider Name (Legal Business Name): EDWARD B PRICE M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/03/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17453 RICHMOND HWY
DUMFRIES VA
22026-2244
US

IV. Provider business mailing address

17453 RICHMOND HWY
DUMFRIES VA
22026
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-3913
  • Fax: 703-221-3913
Mailing address:
  • Phone: 703-221-3913
  • Fax: 703-221-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305103005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: