Provider Demographics
NPI:1043927692
Name:E3 PT AND WELLNESS
Entity Type:Organization
Organization Name:E3 PT AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM-CHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-261-4188
Mailing Address - Street 1:4701 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6221
Mailing Address - Country:US
Mailing Address - Phone:703-261-4188
Mailing Address - Fax:
Practice Address - Street 1:4701 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6221
Practice Address - Country:US
Practice Address - Phone:703-261-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty