Provider Demographics
NPI:1891194668
Name:STAFFORD HEALTHCARE GROUP
Entity Type:Organization
Organization Name:STAFFORD HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PEUTERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:703-878-2250
Mailing Address - Street 1:5886 PICADILLY CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3802
Mailing Address - Country:US
Mailing Address - Phone:703-878-2250
Mailing Address - Fax:
Practice Address - Street 1:5886 PICADILLY CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3802
Practice Address - Country:US
Practice Address - Phone:703-878-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23066003140261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy