=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457166456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPANDING REACH THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2025
-----------------------------------------------------
Last Update Date | 02/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19701 WHITE FAWN DR
-----------------------------------------------------
City | SOUTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-686-0935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19701 WHITE FAWN DR
-----------------------------------------------------
City | SOUTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23803-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-686-0935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. EMILY ROSENBERGER
-----------------------------------------------------
Credential | PT, DPT, CBS
-----------------------------------------------------
Telephone | 443-686-0935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------