Provider Demographics
NPI:1831562073
Name:BENGTSSON, LARS ALEXANDAR N (DPT)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:ALEXANDAR N
Last Name:BENGTSSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42365 SOAVE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4886
Mailing Address - Country:US
Mailing Address - Phone:571-349-3116
Mailing Address - Fax:
Practice Address - Street 1:42365 SOAVE DR
Practice Address - Street 2:STE 200
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-4886
Practice Address - Country:US
Practice Address - Phone:571-349-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist