Healthcare Provider Details

I. General information

NPI: 1801285069
Provider Name (Legal Business Name): CYPRESS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6861 ELM ST STE 2B
MC LEAN VA
22101-3830
US

IV. Provider business mailing address

6861 ELM ST STE 2B
MC LEAN VA
22101-3830
US

V. Phone/Fax

Practice location:
  • Phone: 703-559-3214
  • Fax:
Mailing address:
  • Phone: 703-559-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH BRACKEN
Title or Position: PT
Credential:
Phone: 703-559-3214