Provider Demographics
NPI:1225322134
Name:RENEE PACKER PEDIATRIC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:RENEE PACKER PEDIATRIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PACKER-LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-489-6629
Mailing Address - Street 1:25620 WYNDHAM POINT CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3184
Mailing Address - Country:US
Mailing Address - Phone:703-489-6629
Mailing Address - Fax:703-935-8710
Practice Address - Street 1:25620 WYNDHAM POINT CT
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3184
Practice Address - Country:US
Practice Address - Phone:703-489-6629
Practice Address - Fax:703-935-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050060162251P0200X
VA23052029552251P0200X
VA0119004001225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty