1821033564 NPI number — ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC

Table of content: (NPI 1821033564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821033564 NPI number — ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1821033564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2841 HARTLAND RD
Provider Second Line Business Mailing Address:
SUITE 401B
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-205-1233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 ELDEN ST.
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20170-4876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-205-1233
Provider Business Practice Location Address Fax Number:
703-641-0189
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ERCOLE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
703-205-1233

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305004004 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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