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General NPI Number Information
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NPI Number | 1851120703
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Entity Type | Organization
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Legal Business Name | COMP RX PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 4100 LAFAYETTE CENTER DR STE 114
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City | CHANTILLY
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State | VA
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Zip | 20151-1234
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Country | US
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Telephone | 703-562-0065
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Fax |
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Provider Business Mailing Address
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Address Line | 13437 COMPTON RD
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City | CLIFTON
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State | VA
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Zip | 20124-1202
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Country | US
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Telephone | 703-209-8775
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY SMITH
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Credential | PT, DPT
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Telephone | 703-562-0065
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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 |
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License Number State |
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