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General NPI Number Information
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NPI Number | 1710024286
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Entity Type | Organization
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Legal Business Name | MANUAL THERAPY EFFECTS LLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7900 WESTPARK DR SUITE A030
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City | MCLEAN
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State | VA
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Zip | 22102-4242
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Country | US
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Telephone | 703-848-0881
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Fax | 703-848-0889
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Provider Business Mailing Address
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Address Line | 1204 N INGLEWOOD ST
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City | ARLINGTON
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State | VA
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Zip | 22205-2461
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Country | US
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Telephone | 703-622-0603
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | JAMIE SO
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Credential | MSPT
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Telephone | 703-622-0603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305203639
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License Number State | VA
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