Healthcare Provider Details

I. General information

NPI: 1316906902
Provider Name (Legal Business Name): MARGARET JOHNSTONE TAVES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 LOISDALE RD SUITE 300
SPRINGFIELD VA
22150-1824
US

IV. Provider business mailing address

6506 LOISDALE RD SUITE 300
SPRINGFIELD VA
22150-1824
US

V. Phone/Fax

Practice location:
  • Phone: 702-924-4100
  • Fax: 703-924-5048
Mailing address:
  • Phone: 702-924-4100
  • Fax: 703-924-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305001377
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: