Provider Demographics
NPI:1699396036
Name:LITTLE RIVER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:LITTLE RIVER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:571-276-9337
Mailing Address - Street 1:6321 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1237
Mailing Address - Country:US
Mailing Address - Phone:571-276-9337
Mailing Address - Fax:571-234-6232
Practice Address - Street 1:4216 EVERGREEN LN STE 121
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3256
Practice Address - Country:US
Practice Address - Phone:571-276-9337
Practice Address - Fax:571-234-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty