Healthcare Provider Details

I. General information

NPI: 1336375088
Provider Name (Legal Business Name): CHESAPEAKE CHILDRENS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 LOISDALE RD
SPRINGFIELD VA
22150-1824
US

IV. Provider business mailing address

6506 LOISDALE RD
SPRINGFIELD VA
22150-1824
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305205675
License Number StateVA

VIII. Authorized Official

Name: KIMBERLY HANLON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 703-924-4100