Provider Demographics
NPI:1801971601
Name:COACH HOUSE PHYSICIAL THERAPY&SPORTS MEDICINE CENTER, LLC
Entity type:Organization
Organization Name:COACH HOUSE PHYSICIAL THERAPY&SPORTS MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BROCK
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:703-221-3913
Mailing Address - Street 1:17453 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2244
Mailing Address - Country:US
Mailing Address - Phone:703-221-3913
Mailing Address - Fax:703-221-3203
Practice Address - Street 1:17453 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2244
Practice Address - Country:US
Practice Address - Phone:703-221-3913
Practice Address - Fax:703-221-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305103005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty