Provider Demographics
NPI:1538483243
Name:PRINCE WILLIAM COUNTY PARK AUTHORITY
Entity Type:Organization
Organization Name:PRINCE WILLIAM COUNTY PARK AUTHORITY
Other - Org Name:CHINN AQUATICS & FITNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FITNESS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-730-1060
Mailing Address - Street 1:14420 BRISTOW RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3932
Mailing Address - Country:US
Mailing Address - Phone:703-730-1060
Mailing Address - Fax:703-730-1992
Practice Address - Street 1:13025 CHINN PARK DR
Practice Address - Street 2:
Practice Address - City:PRINCE WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:22192-5073
Practice Address - Country:US
Practice Address - Phone:703-730-1060
Practice Address - Fax:703-730-1992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCE WILLIAM COUNTY PARK AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty