Provider Demographics
NPI:1245741024
Name:PHYSICAL THERAPY YOUR WAY PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY YOUR WAY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-338-3975
Mailing Address - Street 1:9447B LORTON MARKET ST STE 250
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1963
Mailing Address - Country:US
Mailing Address - Phone:703-372-5716
Mailing Address - Fax:
Practice Address - Street 1:9447B LORTON MARKET ST STE 250
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1963
Practice Address - Country:US
Practice Address - Phone:703-372-5716
Practice Address - Fax:703-372-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003310261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy