MEDICARE: VIRAGO 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

General Provider Information

NPI Number	:	1467925966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRAGO PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	812 NANCY LYNN LN
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-3026
Country	:	US
Telephone Number	:	443-758-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 NANCY LYNN LN
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-3026
Country	:	US
Telephone Number	:	443-758-8880
Fax Number	:

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	MS. MARY E NAYLOR
Credential	:	PT
Telephone Number	:	443-333-8792

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	03/04/2019

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