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General NPI Number Information
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NPI Number | 1093127581
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Entity Type | Organization
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Legal Business Name | INOVA
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 6355 WALKER LN
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3245
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Country | US
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Telephone | 703-797-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 6032 SUMNER RD
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1855
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Country | US
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Telephone | 443-350-1435
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY/RESIDENT
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Name | WILLIAM HUEBNER
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Credential |
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Telephone | 443-350-1435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2305208694
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License Number State | VA
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