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General NPI Number Information
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NPI Number | 1316337637
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Entity Type | Organization
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Legal Business Name | THERAPAEDIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 5800 MAPLEDALE PLZ
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4535
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Country | US
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Telephone | 703-680-3332
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Fax | 703-680-1365
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Provider Business Mailing Address
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Address Line | 2621 CROSSVINE DR
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City | DUMFRIES
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State | VA
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Zip | 22026-3053
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Country | US
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Telephone | 404-441-3289
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LINDSEY ANDERSON
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Credential | DPT
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Telephone | 404-441-3289
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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 | 009844
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License Number State | GA
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