Provider Demographics
NPI:1366633208
Name:SCUDDER, ELIZABETH SUSAN (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44927 GEORGE WASHINGTON BLVD
Mailing Address - Street 2:STE. 210
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4295
Mailing Address - Country:US
Mailing Address - Phone:571-291-9936
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD
Practice Address - Street 2:STE. 210
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4295
Practice Address - Country:US
Practice Address - Phone:571-291-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA47610196Medicare PIN