Healthcare Provider Details

I. General information

NPI: 1093626038
Provider Name (Legal Business Name): BRIAN WILLIAMS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 RESTON PKWY STE 403
RESTON VA
20190-3360
US

IV. Provider business mailing address

1760 RESTON PKWY STE 403
RESTON VA
20190-3360
US

V. Phone/Fax

Practice location:
  • Phone: 703-230-1760
  • Fax: 703-230-1761
Mailing address:
  • Phone: 703-230-1760
  • Fax: 703-230-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305218029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: