MEDICARE: GREGORY AYSCUE DPT

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	2305206932	VA

General Provider Information

NPI Number	:	1548555477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY AYSCUE DPT

Provider Business Mailing Address
First Line	:	PO BOX 1769
Second Line	:
City	:	MIDDLEBURG
State	:	VA
Zip	:	20118-1769
Country	:	US
Telephone Number	:	540-687-8181
Fax Number	:	540-687-8256

Provider Business Practice Location Address
First Line	:	5115 LEESBURG PIKE
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-3207
Country	:	US
Telephone Number	:	703-824-0701
Fax Number	:	703-824-0704

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	07/09/2013

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