MEDICARE: MAINSPRING PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305005347	VA

General Provider Information

NPI Number	:	1053613828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINSPRING PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	402 W BROAD ST
Second Line	:	2ND FLOOR
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3337
Country	:	US
Telephone Number	:	240-463-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 W BROAD ST
Second Line	:	2ND FLOOR
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3337
Country	:	US
Telephone Number	:	240-463-4665
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDREW PAUL CICHOSZ
Credential	:
Telephone Number	:	240-463-4665

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	11/29/2010

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