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General NPI Number Information
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NPI Number | 1942750864
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Entity Type | Organization
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Legal Business Name | TRIPPS COURT ASSOCIATES
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1884 VIRGINIA AVE
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City | MC LEAN
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State | VA
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Zip | 22101-4934
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Country | US
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Telephone | 703-534-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 1884 VIRGINIA AVE
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City | MC LEAN
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State | VA
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Zip | 22101-4934
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Country | US
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Telephone | 703-534-1352
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | AMY G PEDULLA
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Credential | DPT
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Telephone | 703-534-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2
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License Number State | VA
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