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General NPI Number Information
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NPI Number | 1093199275
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Entity Type | Organization
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Legal Business Name | HAYMARKET PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 14535 JOHN MARSHALL HWY 203
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City | GAINESVILLE
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State | VA
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Zip | 20155-4023
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Country | US
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Telephone | 703-753-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 14535 JOHN MARSHALL HWY STE 203
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City | GAINESVILLE
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State | VA
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Zip | 20155-4025
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Country | US
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Telephone | 703-753-0261
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JESSICA HOLDAWAY
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Credential |
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Telephone | 571-719-3563
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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 | 2305207830
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License Number State | VA
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