Provider Demographics
NPI:1710024286
Name:MANUAL THERAPY EFFECTS LLC
Entity Type:Organization
Organization Name:MANUAL THERAPY EFFECTS LLC
Other - Org Name:CAPITOL METRO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:703-622-0603
Mailing Address - Street 1:1204 N INGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2461
Mailing Address - Country:US
Mailing Address - Phone:703-622-0603
Mailing Address - Fax:
Practice Address - Street 1:7900 WESTPARK DR
Practice Address - Street 2:SUITE A030
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4242
Practice Address - Country:US
Practice Address - Phone:703-848-0881
Practice Address - Fax:703-848-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052036392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01837Medicare ID - Type UnspecifiedMEDICARE GROUP ID