Provider Demographics
NPI:1558908442
Name:ADVANCED PHYSICAL THERAPY AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL THERAPY AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-749-0223
Mailing Address - Street 1:8230 OLD COURTHOUSE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3840
Mailing Address - Country:US
Mailing Address - Phone:703-749-0223
Mailing Address - Fax:703-749-0225
Practice Address - Street 1:8230 OLD COURTHOUSE RD STE 350
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3840
Practice Address - Country:US
Practice Address - Phone:703-749-0223
Practice Address - Fax:703-749-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty