Healthcare Provider Details

I. General information

NPI: 1023163581
Provider Name (Legal Business Name): THE CHILDREN'S THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARPENTER DR SUITE 140
STERLING VA
20164-7114
US

IV. Provider business mailing address

100 CARPENTER DR STE 140
STERLING VA
20164-4464
US

V. Phone/Fax

Practice location:
  • Phone: 703-707-9060
  • Fax: 703-707-9022
Mailing address:
  • Phone: 703-707-9060
  • Fax: 703-707-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LISA MARIE MACKELL
Title or Position: PRESIDENT
Credential: PT
Phone: 484-787-2267