Provider Demographics
NPI:1134751399
Name:VIRGINIA SPORTS THERAPY
Entity type:Organization
Organization Name:VIRGINIA SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-999-8380
Mailing Address - Street 1:44330 PREMIER PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5071
Mailing Address - Country:US
Mailing Address - Phone:703-723-9355
Mailing Address - Fax:888-972-7952
Practice Address - Street 1:44330 PREMIER PLZ STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5071
Practice Address - Country:US
Practice Address - Phone:703-723-9355
Practice Address - Fax:888-972-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty