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General NPI Number Information
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NPI Number | 1699396036
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Entity Type | Organization
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Legal Business Name | LITTLE RIVER PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 4216 EVERGREEN LN STE 121
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City | ANNANDALE
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State | VA
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Zip | 22003-3256
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Country | US
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Telephone | 571-276-9337
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Fax | 571-234-6232
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Provider Business Mailing Address
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Address Line | 6321 OAK RIDGE DR
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1237
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Country | US
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Telephone | 571-276-9337
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Fax | 571-234-6232
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | LISA MARIE FISHER
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Credential | PT
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Telephone | 571-276-9337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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