Provider Demographics
NPI:1114640695
Name:NORTHSTAR PHYSICAL THERAPY, LLC.
Entity Type:Organization
Organization Name:NORTHSTAR PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:703-594-6314
Mailing Address - Street 1:5003 WESTFIELDS BLVD
Mailing Address - Street 2:PO BOX 230022
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-4119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5130 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-4119
Practice Address - Country:US
Practice Address - Phone:703-594-6314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty