Healthcare Provider Details

I. General information

NPI: 1992684682
Provider Name (Legal Business Name): TARA L THOMPSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 185
SPRINGFIELD VA
22150-2525
US

IV. Provider business mailing address

745 BRUSH LN
COCOA FL
32926-4246
US

V. Phone/Fax

Practice location:
  • Phone: 703-386-7204
  • Fax:
Mailing address:
  • Phone: 703-314-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: