Healthcare Provider Details

I. General information

NPI: 1215605969
Provider Name (Legal Business Name): MICHAEL A TOLERICO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN STE 100
SPRINGFIELD VA
22152-1650
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7335
  • Fax: 703-569-0665
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214712
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: