Provider Demographics
NPI:1326800848
Name:DANCING TREE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:DANCING TREE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-527-9557
Mailing Address - Street 1:12642 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1953
Mailing Address - Country:US
Mailing Address - Phone:703-349-5170
Mailing Address - Fax:
Practice Address - Street 1:12642 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-1953
Practice Address - Country:US
Practice Address - Phone:703-349-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy