Healthcare Provider Details

I. General information

NPI: 1679405328
Provider Name (Legal Business Name): ELLEN SHRIVER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 BUSINESS CENTER DR STE 330
RESTON VA
20190-4882
US

IV. Provider business mailing address

4121 BERRITT ST
FAIRFAX VA
22030-3519
US

V. Phone/Fax

Practice location:
  • Phone: 703-679-7837
  • Fax:
Mailing address:
  • Phone: 703-231-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217713
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: