Provider Demographics
NPI:1639106073
Name:JOHN H AND CATHY R FEDER
Entity Type:Organization
Organization Name:JOHN H AND CATHY R FEDER
Other - Org Name:PHYSICAL THERAPY FOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:703-370-4093
Mailing Address - Street 1:8514 BOUND BROOK LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2114
Mailing Address - Country:US
Mailing Address - Phone:703-780-0631
Mailing Address - Fax:
Practice Address - Street 1:3345 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5219
Practice Address - Country:US
Practice Address - Phone:703-370-4093
Practice Address - Fax:703-370-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTRICARE
059110Medicare ID - Type Unspecified