=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174605687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYMARKET PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14535 JOHN MARSHALL HIGHWAY SUITE 203
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-753-0974
-----------------------------------------------------
Fax | 703-753-9709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14535 JOHN MARSHALL HIGHWAY SUITE 203
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-753-0974
-----------------------------------------------------
Fax | 703-753-9709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN'S ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ANGIE SAGLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-880-9856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------