Provider Demographics
NPI:1134854912
Name:DR RADER ADVANCED PT LLC
Entity type:Organization
Organization Name:DR RADER ADVANCED PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:571-419-6300
Mailing Address - Street 1:8603 WESTWOOD CENTER DR STE 240
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2230
Mailing Address - Country:US
Mailing Address - Phone:571-419-6300
Mailing Address - Fax:571-419-6302
Practice Address - Street 1:8603 WESTWOOD CENTER DR STE 240
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2230
Practice Address - Country:US
Practice Address - Phone:571-419-6300
Practice Address - Fax:571-419-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty