Provider Demographics
NPI:1275932584
Name:DEFINE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:DEFINE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILEY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PEPPERS
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:240-286-3822
Mailing Address - Street 1:2657 CENTENNIAL CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1303
Mailing Address - Country:US
Mailing Address - Phone:240-286-3822
Mailing Address - Fax:
Practice Address - Street 1:2657 CENTENNIAL CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1303
Practice Address - Country:US
Practice Address - Phone:240-286-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052072662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty