Provider Demographics
NPI:1013555150
Name:ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERCOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-205-1233
Mailing Address - Street 1:2841 HARTLAND RD STE 401B
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3500
Mailing Address - Country:US
Mailing Address - Phone:703-205-1233
Mailing Address - Fax:703-641-0189
Practice Address - Street 1:5860 COLUMBIA PIKE STE 104
Practice Address - Street 2:
Practice Address - City:BAILEYS CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22041-2038
Practice Address - Country:US
Practice Address - Phone:703-205-1233
Practice Address - Fax:703-641-0189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy