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NPI Code Detail

MEDICARE: ELLEN THERESE EGERTON PT

MEDICARE: ELLEN THERESE EGERTON PT
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
1174400000XSpecialist2305002834VA

General Provider Information

NPI Number : 1780604892
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN THERESE EGERTON PT
Provider Business Mailing Address
First Line : 4321 DONNA MARIE CT
Second Line :
City : HAYMARKET
State : VA
Zip : 20169-1746
Country : US
Telephone Number : 703-777-0528
Fax Number :
Provider Business Practice Location Address
First Line : 906 TRAILVIEW BLVD SE
Second Line :
City : LEESBURG
State : VA
Zip : 20175-4415
Country : US
Telephone Number : 703-777-0528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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Directions to “ ELLEN THERESE EGERTON PT” Practice Location

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