Provider Demographics
NPI:1346812047
Name:EMPOWER PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LAUSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-944-7675
Mailing Address - Street 1:20817 MINTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4003
Mailing Address - Country:US
Mailing Address - Phone:703-944-7675
Mailing Address - Fax:703-669-6101
Practice Address - Street 1:22 FAIRFAX ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3616
Practice Address - Country:US
Practice Address - Phone:703-669-6100
Practice Address - Fax:703-669-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy