Provider Demographics
NPI:1629128152
Name:LOUDOUN PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:LOUDOUN PHYSICAL THERAPY, INC.
Other - Org Name:LOUDOUN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:703-443-6700
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4171
Mailing Address - Country:US
Mailing Address - Phone:703-443-6700
Mailing Address - Fax:703-443-6702
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4171
Practice Address - Country:US
Practice Address - Phone:703-443-6700
Practice Address - Fax:703-443-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08589Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER