Provider Demographics
NPI:1124553664
Name:NOVA INTEGRATIVE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NOVA INTEGRATIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STARACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-687-3497
Mailing Address - Street 1:2003 BARKHAM LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5002
Mailing Address - Country:US
Mailing Address - Phone:732-687-3497
Mailing Address - Fax:
Practice Address - Street 1:2003 BARKHAM LN
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5002
Practice Address - Country:US
Practice Address - Phone:732-687-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206813261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy