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General NPI Number Information
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NPI Number | 1124553664
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Entity Type | Organization
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Legal Business Name | NOVA INTEGRATIVE PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 2003 BARKHAM LN
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City | VIENNA
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State | VA
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Zip | 22182-5002
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Country | US
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Telephone | 732-687-3497
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 BARKHAM LN
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City | VIENNA
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State | VA
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Zip | 22182-5002
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Country | US
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Telephone | 732-687-3497
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | LAUREN STARACE
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Credential |
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Telephone | 732-687-3497
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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 | 2305206813
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License Number State | VA
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