Provider Demographics
NPI:1932652666
Name:BLUE SKYY LLC
Entity Type:Organization
Organization Name:BLUE SKYY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-372-4445
Mailing Address - Street 1:43130 AMBERWOOD PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4105
Mailing Address - Country:US
Mailing Address - Phone:703-372-4445
Mailing Address - Fax:703-957-3365
Practice Address - Street 1:43130 AMBERWOOD PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4105
Practice Address - Country:US
Practice Address - Phone:703-372-4445
Practice Address - Fax:703-957-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty