Healthcare Provider Details

I. General information

NPI: 1740725811
Provider Name (Legal Business Name): JOHN T SALLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8644 SUDLEY ROAD SUITE 308
MANNASSAS VA
20110
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5303
  • Fax:
Mailing address:
  • Phone: 804-915-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305209983
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: