Healthcare Provider Details

I. General information

NPI: 1497599369
Provider Name (Legal Business Name): PURE MOVEMENT PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BLENHEIM BLVD STE 21C
FAIRFAX VA
22030-2432
US

IV. Provider business mailing address

4415 GLENN ROSE ST
FAIRFAX VA
22032-1226
US

V. Phone/Fax

Practice location:
  • Phone: 703-679-7525
  • Fax:
Mailing address:
  • Phone: 443-745-3185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY B O'KEEFE
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 443-745-3185