Healthcare Provider Details

I. General information

NPI: 1053616755
Provider Name (Legal Business Name): MARIA CATALINA LEMCKE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 JOHN MARSHALL HWY SUITE 203
GAINESVILLE VA
20155-4023
US

IV. Provider business mailing address

14535 JOHN MARSHALL HWY SUITE 203
GAINESVILLE VA
20155-4023
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-0974
  • Fax: 703-753-9709
Mailing address:
  • Phone: 703-753-0974
  • Fax: 703-753-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206752
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: