Provider Demographics
NPI:1275604415
Name:MCLEAN PHYSICAL THERAPY & REHAB SERVICES, LLC.
Entity Type:Organization
Organization Name:MCLEAN PHYSICAL THERAPY & REHAB SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-356-7801
Mailing Address - Street 1:1515 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4451
Mailing Address - Country:US
Mailing Address - Phone:703-356-7801
Mailing Address - Fax:703-356-7814
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE #104
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4451
Practice Address - Country:US
Practice Address - Phone:703-356-7801
Practice Address - Fax:703-356-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJ684OtherBCBS
VA3318097OtherAETNA HMO
VA7400481OtherAETNA PPO
VA7400481OtherAETNA PPO
VA3318097OtherAETNA HMO