Provider Demographics
NPI:1154448553
Name:STRAIT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:STRAIT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CHIEF PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, COMT
Authorized Official - Phone:703-860-2346
Mailing Address - Street 1:2579 JOHN MILTON DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2563
Mailing Address - Country:US
Mailing Address - Phone:703-860-2346
Mailing Address - Fax:703-860-2348
Practice Address - Street 1:2579 JOHN MILTON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2563
Practice Address - Country:US
Practice Address - Phone:703-860-2346
Practice Address - Fax:703-860-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02082S01Medicare ID - Type Unspecified