Provider Demographics
NPI:1578913737
Name:THE CHILDREN'S THERAPY CENTER
Entity Type:Organization
Organization Name:THE CHILDREN'S THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACKELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:484-787-2267
Mailing Address - Street 1:8348 TRAFORD LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1663
Mailing Address - Country:US
Mailing Address - Phone:703-569-7500
Mailing Address - Fax:703-866-0158
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 175
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3065
Practice Address - Country:US
Practice Address - Phone:703-291-1254
Practice Address - Fax:571-248-0304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHILDREN'S THERAPY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-20
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050016072251P0200X
VA1457491391225XP0200X
VA2202008072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty