=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275067761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERK PHYSICAL THERAPY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2017
-----------------------------------------------------
Last Update Date | 08/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7816 THOR DR
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-431-5462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7816 THOR DR
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-431-5462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. JENNIFER MERKEL
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 703-431-5462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 2305004391
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------