MEDICARE: LIL RASCALS PEDIATRIC THERAPY, PTLLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1215809157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIL RASCALS PEDIATRIC THERAPY, PTLLC

Provider Business Mailing Address
First Line	:	2400 24TH RD S APT 356
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2653
Country	:	US
Telephone Number	:	571-932-3367
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 24TH RD S APT 356
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2653
Country	:	US
Telephone Number	:	571-932-3367
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	SIERRA ALICIA DESORME
Credential	:	OTD
Telephone Number	:	571-932-3367

Provider Enumeration Date	:	09/20/2025
Last Update Date	:	09/20/2025

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