Provider Demographics
NPI:1558564526
Name:CENTREVILLE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:CENTREVILLE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRYSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-222-5903
Mailing Address - Street 1:14631 LEE HWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2112
Mailing Address - Country:US
Mailing Address - Phone:703-222-5903
Mailing Address - Fax:703-222-3765
Practice Address - Street 1:14631 LEE HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2112
Practice Address - Country:US
Practice Address - Phone:703-222-5903
Practice Address - Fax:703-222-3765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAANTHEMOther196835
VAANTHEMOther196835