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General NPI Number Information
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NPI Number | 1871959726
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Entity Type | Organization
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Legal Business Name | PRIMUS PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 6101 REDWOOD SQUARE CTR SUITE 202
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City | CENTREVILLE
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State | VA
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Zip | 20121
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Country | US
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Telephone | 703-543-6660
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Fax | 703-995-0284
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Provider Business Mailing Address
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Address Line | 6101 REDWOOD SQUARE CTR SUITE 202
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City | CENTREVILLE
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State | VA
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Zip | 20121-4265
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Country | US
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Telephone | 301-642-5096
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Fax | 703-995-0284
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Authorized Official
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Title or Position | CLINICAL SERVICES DIRECTOR
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Name | DR. JACQUELINE DE CONTI
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Credential | DPT
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Telephone | 443-812-9890
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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 | 230525109
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License Number State | VA
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