Provider Demographics
NPI:1467925966
Name:VIRAGO PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:VIRAGO PHYSICAL THERAPY, LLC
Other - Org Name:VIRAGO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:443-333-8792
Mailing Address - Street 1:812 NANCY LYNN LN
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-3026
Mailing Address - Country:US
Mailing Address - Phone:443-758-8880
Mailing Address - Fax:
Practice Address - Street 1:812 NANCY LYNN LN
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-3026
Practice Address - Country:US
Practice Address - Phone:443-758-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty