MEDICARE: KARLA WORTMAN PT

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	2305004302	VA

General Provider Information

NPI Number	:	1114927787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA WORTMAN PT

Provider Business Mailing Address
First Line	:	9900 MAIN ST
Second Line	:	SUITE 200A
City	:	FAIRFAX
State	:	VA
Zip	:	22031-3907
Country	:	US
Telephone Number	:	703-279-4394
Fax Number	:	703-279-4214

Provider Business Practice Location Address
First Line	:	8348 TRAFORD LN
Second Line	:	SUITE 100
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1663
Country	:	US
Telephone Number	:	703-569-7335
Fax Number	:	703-569-0665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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