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NPI Code Detail

MEDICARE: ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC

MEDICARE: ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1588960249
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Provider Business Mailing Address
First Line : 2841 HARTLAND RD STE 401B
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22043-3500
Country : US
Telephone Number : 703-205-1233
Fax Number : 703-641-0189
Provider Business Practice Location Address
First Line : 131 ELDEN ST STE 308
Second Line :
City : HERNDON
State : VA
Zip : 20170-4851
Country : US
Telephone Number : 703-205-1233
Fax Number : 703-641-0189
Authorized Official
Title or Position : INSTITUTE DIRECTOR
Name : MICHAEL A ERCOLE
Credential : PT
Telephone Number : 703-205-1233
Provider Enumeration Date : 01/28/2011
Last Update Date : 08/28/2012

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