Healthcare Provider Details

I. General information

NPI: 1629128152
Provider Name (Legal Business Name): LOUDOUN PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST SUITE B
LEESBURG VA
20176-4171
US

IV. Provider business mailing address

525 E MARKET ST SUITE B
LEESBURG VA
20176-4171
US

V. Phone/Fax

Practice location:
  • Phone: 703-443-6700
  • Fax: 703-443-6702
Mailing address:
  • Phone: 703-443-6700
  • Fax: 703-443-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. GENEVIEVE E. GRIFFIN
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 703-443-6700