Provider Demographics
NPI:1346897204
Name:DOMINION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:DOMINION PHYSICAL THERAPY, LLC
Other - Org Name:DOMINION PHYSICAL THERAPY, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:571-427-4378
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-0852
Mailing Address - Country:US
Mailing Address - Phone:571-427-4378
Mailing Address - Fax:
Practice Address - Street 1:3695 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2049
Practice Address - Country:US
Practice Address - Phone:540-460-2751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-24
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy