=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902509664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVAMOTION PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2023
-----------------------------------------------------
Last Update Date | 08/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8996 BURKE LAKE RD STE 104
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-594-6765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8996 BURKE LAKE RD STE 104
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-594-6765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/OWNER
-----------------------------------------------------
Name | DR. SHIRA WEISS
-----------------------------------------------------
Credential | PT, DPT, CCTT
-----------------------------------------------------
Telephone | 703-395-5853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------