Provider Demographics
NPI:1659085371
Name:IN-HOME PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:IN-HOME PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DABOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-406-8833
Mailing Address - Street 1:9006 WINDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9006 WINDFLOWER LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-4057
Practice Address - Country:US
Practice Address - Phone:571-406-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty