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General NPI Number Information
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NPI Number | 1306070164
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Entity Type | Organization
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Legal Business Name | MID-COUNTY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 12581 MILSTEAD WAY SUITE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 703-763-3922
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Fax |
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Provider Business Mailing Address
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Address Line | 12581 MILSTEAD WAY SUITE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 703-763-3922
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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 | MR. CHARLES SHERMAN MILLS III
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Credential | PT
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Telephone | 703-763-3922
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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 | 2305006481
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License Number State | VA
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