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General NPI Number Information
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NPI Number | 1770544397
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Entity Type | Organization
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Legal Business Name | STILL WATER PHYSICAL THERAPY , PLLC
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 15611 ANDOVER HEIGHTS DRIVE
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1072
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Country | US
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Telephone | 703-583-6899
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Fax | 703-583-6899
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Provider Business Mailing Address
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Address Line | 15611 ANDOVER HEIGHTS DRIVE
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1072
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Country | US
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Telephone | 703-583-6899
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Fax | 703-583-6899
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATHLEEN SAILE HESS
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Credential | PT
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Telephone | 703-583-6899
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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 | 2305005991
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License Number State | VA
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