Healthcare Provider Details

I. General information

NPI: 1992133037
Provider Name (Legal Business Name): PEDIATRIC THERAPY STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8227 OLD - COURTHOUSE RD #115
VIENNA VA
22182
US

IV. Provider business mailing address

8221 OLD COURTHOUSE RD SUITE 105
VIENNA VA
22182-3839
US

V. Phone/Fax

Practice location:
  • Phone: 703-663-4808
  • Fax: 703-665-1241
Mailing address:
  • Phone: 703-663-4808
  • Fax: 844-764-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006160
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA HALIM
Title or Position: CLINICAL MANAGER
Credential:
Phone: 703-638-3056