Provider Demographics
NPI:1770544397
Name:STILL WATER PHYSICAL THERAPY , PLLC
Entity type:Organization
Organization Name:STILL WATER PHYSICAL THERAPY , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:SAILE
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-583-6899
Mailing Address - Street 1:15611 ANDOVER HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1072
Mailing Address - Country:US
Mailing Address - Phone:703-583-6899
Mailing Address - Fax:703-583-6899
Practice Address - Street 1:15611 ANDOVER HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1072
Practice Address - Country:US
Practice Address - Phone:703-583-6899
Practice Address - Fax:703-583-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12070Medicare UPIN
VA650000369Medicare ID - Type Unspecified