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General NPI Number Information
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NPI Number | 1144395039
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Entity Type | Organization
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Legal Business Name | SPORTS INJURY THERAPY CLINIC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4600 DUKE ST SUITE 423
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2552
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Country | US
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Telephone | 703-461-7109
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Fax | 703-461-7331
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Provider Business Mailing Address
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Address Line | 4600 DUKE ST SUITE 423
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2552
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Country | US
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Telephone | 703-461-7109
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Fax | 703-461-7331
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. WEI P PENG
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Credential | LAC
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Telephone | 703-461-7109
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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 | 0121000209
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License Number State | VA
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