=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003915000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUDOUN SPORTS THERAPY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21355 RIDGETOP CIR STE 310
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20166-8500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-450-4300
-----------------------------------------------------
Fax | 703-450-5113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21355 RIDGETOP CIR STE 310
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20166-8500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-450-4300
-----------------------------------------------------
Fax | 703-450-5113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL J BILLS
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 703-450-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------