Provider Demographics
NPI:1437689932
Name:EASTERN CRANIAL AFFILIATES, LLC
Entity Type:Organization
Organization Name:EASTERN CRANIAL AFFILIATES, LLC
Other - Org Name:INFINITE LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TERPENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-807-5899
Mailing Address - Street 1:10523 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3310
Mailing Address - Country:US
Mailing Address - Phone:703-807-5899
Mailing Address - Fax:703-807-1183
Practice Address - Street 1:10523 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3310
Practice Address - Country:US
Practice Address - Phone:703-807-5899
Practice Address - Fax:703-807-1183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN CRANIAL AFFILIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy