Healthcare Provider Details

I. General information

NPI: 1184778920
Provider Name (Legal Business Name): MEREDITH CROWLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 LOISDALE RD # 302
SPRINGFIELD VA
22150-1824
US

IV. Provider business mailing address

6732 TAPPS FORD RD
AMISSVILLE VA
20106-3412
US

V. Phone/Fax

Practice location:
  • Phone: 703-924-4100
  • Fax: 703-922-5048
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305206628
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: