Healthcare Provider Details

I. General information

NPI: 1427632181
Provider Name (Legal Business Name): LILLIAN SUTHERLIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLIAN FLORES DPT

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14605 POTOMAC BRANCH DR STE 300
WOODBRIDGE VA
22191-3337
US

IV. Provider business mailing address

14605 POTOMAC BRANCH DR
WOODBRIDGE VA
22191-3336
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1112
  • Fax: 703-878-8735
Mailing address:
  • Phone: 703-490-1112
  • Fax: 703-878-8735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: