Healthcare Provider Details

I. General information

NPI: 1700700903
Provider Name (Legal Business Name): MONTICELLO MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 JEFFERSON DR
PALMYRA VA
22963-2607
US

IV. Provider business mailing address

312 JEFFERSON DR
PALMYRA VA
22963-2607
US

V. Phone/Fax

Practice location:
  • Phone: 301-751-4635
  • Fax:
Mailing address:
  • Phone: 301-751-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDAN FREEMAN MCNULTY
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 804-424-0405