Healthcare Provider Details

I. General information

NPI: 1144774852
Provider Name (Legal Business Name): RICHARD YOO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

V. Phone/Fax

Practice location:
  • Phone: 844-549-0597
  • Fax:
Mailing address:
  • Phone: 844-549-0597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60721848
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016271
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211723
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: