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General NPI Number Information
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NPI Number | 1356110878
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Entity Type | Organization
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Legal Business Name | CORE ACTIVE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 41180 TURKEY OAK DR
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City | ALDIE
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State | VA
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Zip | 20105-5869
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Country | US
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Telephone | 571-245-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 41180 TURKEY OAK DR
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City | ALDIE
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State | VA
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Zip | 20105-5869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | CHRISTINA WILSON
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Credential | DPT
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Telephone | 571-245-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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