Healthcare Provider Details

I. General information

NPI: 1922918135
Provider Name (Legal Business Name): RYAN MILLS COFFELT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 EXECUTIVE PARK AVE STE 100
FAIRFAX VA
22031-2228
US

IV. Provider business mailing address

2647 STONERIDGE RD
WINCHESTER VA
22601-2876
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-7888
  • Fax:
Mailing address:
  • Phone: 540-313-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305218022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: