Provider Demographics
NPI:1043965098
Name:PEUTERBAUGH, IAN ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:ANDREW
Last Name:PEUTERBAUGH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9127 PANTHER FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-6109
Mailing Address - Country:US
Mailing Address - Phone:703-853-8133
Mailing Address - Fax:
Practice Address - Street 1:101 W 14TH ST
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3607
Practice Address - Country:US
Practice Address - Phone:540-636-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist