Provider Demographics
NPI:1811213374
Name:INNOVATIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:540-270-2149
Mailing Address - Street 1:381 STUYVESANT ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2400
Mailing Address - Country:US
Mailing Address - Phone:540-270-2149
Mailing Address - Fax:
Practice Address - Street 1:381 STUYVESANT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2400
Practice Address - Country:US
Practice Address - Phone:540-270-2149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy