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General NPI Number Information
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NPI Number | 1811213374
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 381 STUYVESANT ST SUITE 4
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City | WARRENTON
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State | VA
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Zip | 20186-2400
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Country | US
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Telephone | 540-270-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 381 STUYVESANT ST
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City | WARRENTON
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State | VA
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Zip | 20186-2400
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Country | US
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Telephone | 540-270-2149
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE ROYAL
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Credential | PT, MSPT
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Telephone | 540-270-2149
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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 |
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License Number State |
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