Healthcare Provider Details

I. General information

NPI: 1477906055
Provider Name (Legal Business Name): INDUSTRIAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 BRADDOCK RD SUITE 100
SPRINGFIELD VA
22151-2115
US

IV. Provider business mailing address

PO BOX 316
OAKTON VA
22124-0316
US

V. Phone/Fax

Practice location:
  • Phone: 800-521-8065
  • Fax: 703-842-8416
Mailing address:
  • Phone: 800-521-8065
  • Fax: 703-842-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305210019
License Number StateVA

VIII. Authorized Official

Name: TABATHA JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 800-521-8065