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General NPI Number Information
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NPI Number | 1245666866
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCED PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 21785 FILIGREE CT SUITE 102
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City | ASHBURN
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State | VA
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Zip | 20147-6213
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Country | US
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Telephone | 517-223-7686
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Fax | 571-291-3165
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Provider Business Mailing Address
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Address Line | 21785 FILIGREE CT SUITE 102
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City | ASHBURN
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State | VA
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Zip | 20147-6213
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Country | US
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Telephone | 517-223-7686
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Fax | 571-291-3165
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH BURNETT
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Credential |
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Telephone | 571-223-7686
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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 | 2305006615
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License Number State | VA
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