Healthcare Provider Details

I. General information

NPI: 1164629119
Provider Name (Legal Business Name): ARTHRITIS & SPORTS ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR SUITE 100
STERLING VA
20166-6580
US

IV. Provider business mailing address

21475 RIDGETOP CIR SUITE 100
STERLING VA
20166-6580
US

V. Phone/Fax

Practice location:
  • Phone: 703-433-2500
  • Fax: 703-433-2558
Mailing address:
  • Phone: 703-433-2500
  • Fax: 703-433-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002558
License Number StateVA

VIII. Authorized Official

Name: DR. RANDALL PEYTON
Title or Position: DIRECTOR
Credential: MD
Phone: 703-444-5000