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General NPI Number Information
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NPI Number | 1053613828
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Entity Type | Organization
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Legal Business Name | MAINSPRING PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 402 W BROAD ST 2ND FLOOR
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3337
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Country | US
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Telephone | 240-463-4665
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Fax |
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Provider Business Mailing Address
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Address Line | 402 W BROAD ST 2ND FLOOR
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3337
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Country | US
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Telephone | 240-463-4665
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDREW PAUL CICHOSZ
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Credential |
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Telephone | 240-463-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305005347
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License Number State | VA
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