Provider Demographics
NPI:1376614628
Name:AID PERFORMANCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:AID PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:AID PPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:I
Authorized Official - Last Name:DOMBEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-723-6758
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:703-723-6758
Mailing Address - Fax:703-723-6759
Practice Address - Street 1:20925 PROFESSIONAL PLZ STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:703-723-6758
Practice Address - Fax:703-723-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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