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NPI Code Detail

MEDICARE: DR. ELLEN SHRIVER PT, DPT

MEDICARE: DR. ELLEN SHRIVER PT, 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
1225100000XPhysical Therapist2305217713VA

General Provider Information

NPI Number : 1679405328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN SHRIVER PT, DPT
Provider Business Mailing Address
First Line : 4121 BERRITT ST
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-3519
Country : US
Telephone Number : 703-231-3983
Fax Number :
Provider Business Practice Location Address
First Line : 1768 BUSINESS CENTER DR STE 330
Second Line :
City : RESTON
State : VA
Zip : 20190-4882
Country : US
Telephone Number : 703-679-7837
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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