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General NPI Number Information
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NPI Number | 1063867844
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Entity Type | Organization
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Legal Business Name | SPORTS CARE ACUPUNCTURE CLINIC, LLC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 7535 LITTLE RIVER TNPK #103A
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City | ANNANDALE
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State | VA
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Zip | 22003
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Country | US
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Telephone | 703-859-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 7535 LITTLE RIVER TPKE STE 103A
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City | ANNANDALE
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State | VA
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Zip | 22003-2983
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Country | US
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Telephone | 703-859-1102
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST / OWNER
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Name | JULIA LEE
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Credential |
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Telephone | 703-859-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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