Provider Demographics
NPI:1801930631
Name:ALPHA PHYSICAL THERAPY ACCUPUNCTURE AND HERBS CENTER. LLC
Entity type:Organization
Organization Name:ALPHA PHYSICAL THERAPY ACCUPUNCTURE AND HERBS CENTER. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-890-1717
Mailing Address - Street 1:2826 OLD LEE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4323
Mailing Address - Country:US
Mailing Address - Phone:703-890-1717
Mailing Address - Fax:703-206-0029
Practice Address - Street 1:2826 OLD LEE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:703-890-1717
Practice Address - Fax:703-206-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204167261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy