MEDICARE: ADVANCED PT AND REHAB

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	2305203347	VA

General Provider Information

NPI Number	:	1104942671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PT AND REHAB

Provider Business Mailing Address
First Line	:	PO BOX 882
Second Line	:
City	:	MERRIFIELD
State	:	VA
Zip	:	22116-2882
Country	:	US
Telephone Number	:	703-868-1691
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 RICHMOND HWY
Second Line	:	SUITE 100
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-2157
Country	:	US
Telephone Number	:	703-868-1691
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SONIA KELLY
Credential	:
Telephone Number	:	703-868-1691

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/22/2020

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Directions to “ADVANCED PT AND REHAB ” Practice Location

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