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General NPI Number Information
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NPI Number | 1104068717
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Entity Type | Organization
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Legal Business Name | ELITE SPORTS REHABILITATION P C
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 1240 N PITT ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-5600
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Country | US
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Telephone | 703-739-0456
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Fax | 703-739-0032
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Provider Business Mailing Address
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Address Line | 1240 N PITT ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-5600
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Country | US
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Telephone | 703-739-0456
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Fax | 703-739-0032
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Authorized Official
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Title or Position | PHYSICIAN ADMINISTRATOR
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Name | ANGIE SAGLE
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Credential |
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Telephone | 571-330-3165
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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 | 2305204844
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License Number State | VA
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