Provider Demographics
NPI:1568929511
Name:COMMONWEALTH THERAPY COMPANY LLC
Entity Type:Organization
Organization Name:COMMONWEALTH THERAPY COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:O'DOHERTY
Authorized Official - Last Name:DI VINCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:541-771-0163
Mailing Address - Street 1:1796 DUFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1171
Mailing Address - Country:US
Mailing Address - Phone:541-771-0163
Mailing Address - Fax:
Practice Address - Street 1:1796 DUFFIELD LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1171
Practice Address - Country:US
Practice Address - Phone:541-771-0163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency