Provider Demographics
NPI:1821033564
Name:ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ERCOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-205-1233
Mailing Address - Street 1:2841 HARTLAND RD
Mailing Address - Street 2:SUITE 401B
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043
Mailing Address - Country:US
Mailing Address - Phone:703-205-1233
Mailing Address - Fax:
Practice Address - Street 1:108 ELDEN ST.
Practice Address - Street 2:SUITE 12
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4876
Practice Address - Country:US
Practice Address - Phone:703-205-1233
Practice Address - Fax:703-641-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID
VAG02458Medicare PIN