Healthcare Provider Details

I. General information

NPI: 1225471501
Provider Name (Legal Business Name): ROBERT L WOELKERS DPT, PT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 JOHN MARSHALL HWY
GAINESVILLE VA
20155-4023
US

IV. Provider business mailing address

14535 JOHN MARSHALL HWY
GAINESVILLE VA
20155-4023
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: