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General NPI Number Information
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NPI Number | 1528565827
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Entity Type | Organization
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Legal Business Name | SPORTS PT LAB
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 350 S WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4400
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Country | US
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Telephone | 703-402-3541
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Fax |
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Provider Business Mailing Address
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Address Line | 7371 ATLAS WALK WAY # 170
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City | GAINESVILLE
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State | VA
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Zip | 20155-2992
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Country | US
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Telephone | 703-402-3541
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | KRISTIN SYKES
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Credential | DPT
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Telephone | 703-402-3541
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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 | 2305207515
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License Number State | VA
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