Provider Demographics
NPI:1417370339
Name:ASCEND PHYSICAL THERAPY & WELLNESS INC.
Entity Type:Organization
Organization Name:ASCEND PHYSICAL THERAPY & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-304-4427
Mailing Address - Street 1:303 MAPLE AVE W
Mailing Address - Street 2:SUITE F
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4312
Mailing Address - Country:US
Mailing Address - Phone:703-272-8801
Mailing Address - Fax:
Practice Address - Street 1:303 MAPLE AVE W
Practice Address - Street 2:SUITE F
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4312
Practice Address - Country:US
Practice Address - Phone:703-272-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA355524Medicare PIN